National trends, predictors of use, and in-hospital outcomes in mechanical circulatory support for cardiogenic shock

Strom, Jordan B.; Zhao, Yuansong; Shen, Changyu; Chung, Mabel; Pinto, Duane S.; Popma, Jeffrey J.; Yeh, Robert W.

doi:10.4244/eij-d-17-00947

Cited by 66 publications

(45 citation statements)

References 29 publications

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“…With the exception of the IMPRESS-in-Severe-SHOCK trial, which included younger patients, the age of included patients in previous RCTs of active MCS was similar to the present study [14,[22][23][24]. On the other hand, previous cohort studies showed a lower age of patients receiving active MCS, which might be due to selection bias [17,27,31,32]. The shock index, which was identified as a strong outcome predictor in STEMI patients, was higher in patients receiving active MCS [33].…”

Section: Clinical Characteristics and Rates Of Mcs Implementationsupporting

confidence: 75%

Prognostic Impact of Active Mechanical Circulatory Support in Cardiogenic Shock Complicating Acute Myocardial Infarction, Results from the Culprit-Shock Trial

Feistritzer

Desch

Freund

et al. 2020

JCM

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Objectives: To analyze the use and prognostic impact of active mechanical circulatory support (MCS) devices in a large prospective contemporary cohort of patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI). Background: Although increasingly used in clinical practice, data on the efficacy and safety of active MCS devices in patients with CS complicating AMI are limited. Methods: This is a predefined subanalysis of the CULPRIT-SHOCK randomized trial and prospective registry. Patients with CS, AMI and multivessel coronary artery disease were categorized in two groups: (1) use of at least one active MCS device vs. (2) no active MCS or use of intra-aortic balloon pump (IABP) only. The primary endpoint was a composite of all-cause death or renal replacement therapy at 30 days. Results: Two hundred of 1055 (19%) patients received at least one active MCS device (n = 112 Impella®; n = 95 extracorporeal membrane oxygenation (ECMO); n = 6 other devices). The primary endpoint occurred significantly more often in patients treated with active MCS devices compared with those without active MCS devices (142 of 197, 72% vs. 374 of 827, 45%; p < 0.001). All-cause mortality and bleeding rates were significantly higher in the active MCS group (all p < 0.001). After multivariable adjustment, the use of active MCS was significantly associated with the primary endpoint (odds ratio (OR) 4.0, 95% confidence interval (CI) 2.7–5.9; p < 0.001). Conclusions: In the CULPRIT-SHOCK trial, active MCS devices were used in approximately one fifth of patients. Patients treated with active MCS devices showed worse outcome at 30 days and 1 year.

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Section: Clinical Characteristics and Rates Of Mcs Implementationsupporting

confidence: 75%

Prognostic Impact of Active Mechanical Circulatory Support in Cardiogenic Shock Complicating Acute Myocardial Infarction, Results from the Culprit-Shock Trial

Feistritzer

Desch

Freund

et al. 2020

JCM

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“…To date, the Intra-aortic Balloon Pump (IABP)-SHOCK II trial is the only adequately powered randomised controlled trial assessing the use of MCS in AMICS, and the trial failed to show any prognostic benefit with the use of IABP 3. Contemporary studies on temporal trends in use of MCS in AMICS are limited but generally show a shift in choice of the device with a decrease in the use of IABP and an increase in the use of other devices, namely, venoarterial extracorporeal membrane oxygenation (VA-ECMO) and transvalvular microaxial flow pumps 4 5. In a recent retrospective study, general use of Impella was not associated with improved survival compared with the IABP 6.…”

Section: Introductionmentioning

confidence: 99%

Contemporary trends in use of mechanical circulatory support in patients with acute MI and cardiogenic shock

et al. 2020

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ObjectivesTo describe the contemporary trends in the use of mechanical circulatory support (MCS) in patients with acute myocardial infarction and cardiogenic shock (AMICS). To evaluate survival benefit with early application of intra-aortic balloon pump (IABP) or Impella CP.MethodsA cohort study of all consecutive patients with AMICS undergoing percutaneous coronary intervention (PCI) <24 hours of symptom onset (early PCI) in southeastern Denmark from 2010 to 2017. A matched case–control study comparing 30-day mortality between patients receiving early-IABP or early-Impella CP and their respective control group. Controls were matched on age, left ventricular ejection fraction, arterial lactate, estimated glomerular filtration rate and cardiac arrest before PCI. Early-IABP/Impella CP was defined as applied before PCI if shock developed pre-PCI, or immediately after PCI if shock developed during PCI.Results903 patients with AMICS undergoing early PCI were identified. Use of MCS decreased from 50% in 2010 to 25% in 2017, p for trend of <0.001. The IABP was abandoned in 2012 and replaced mostly by Impella CP. Patients receiving MCS in 2013–2017 had more compromised haemodynamics compared with patients receiving MCS in 2010–2012. 40 patients received early IABP, and 40 patients received early Impella CP. Only the group receiving early Impella CP was associated with lower 30-day mortality compared with their matched control group (30-day mortality 40% vs 77.5%, plog-rank of<0.001).ConclusionUse of MCS decreased by 50% from 2010 to 2017. Patients receiving MCS had more compromised haemodynamics in recent years. Early application of Impella CP was associated with reduced 30-day mortality compared with a matched control group.

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“…Use of ECMO has been increasing both nationally(1-4) and internationally, (5) particularly in the setting of cardiogenic shock (CS). (4,6) While ECMO can provide rapid stabilization of the patient in extremis, it remains a morbid (7)(8)(9) and resource-intensive therapy. (10) Appropriate selection of patients who could derive the greatest benefit from this therapy remains a challenge prompting ongoing efforts to identify determinants of outcomes.…”

Section: Introductionmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation Use in Cardiogenic Shock: Impact of Age on In-Hospital Mortality, Length of Stay, and Costs

Chung

Zhao

Strom

et al. 2019

Critical Care Medicine

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National trends, predictors of use, and in-hospital outcomes in mechanical circulatory support for cardiogenic shock

Abstract: In-hospital mortality for CS has declined but remains high. Rates of CS have outpaced MCS utilisation which remains uncommon in non-MI hospitalisations with shock. MCS is associated with utilisation of other procedures during hospitalisation.

Cited by 66 publications

References 29 publications

Prognostic Impact of Active Mechanical Circulatory Support in Cardiogenic Shock Complicating Acute Myocardial Infarction, Results from the Culprit-Shock Trial

Prognostic Impact of Active Mechanical Circulatory Support in Cardiogenic Shock Complicating Acute Myocardial Infarction, Results from the Culprit-Shock Trial

Contemporary trends in use of mechanical circulatory support in patients with acute MI and cardiogenic shock

Extracorporeal Membrane Oxygenation Use in Cardiogenic Shock: Impact of Age on In-Hospital Mortality, Length of Stay, and Costs

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