Prognostic implications of pulmonary artery catheter monitoring in patients with cardiogenic shock: A systematic review and meta-analysis of observational studies

Bertaina, Maurizio; Galluzzo, Alessandro; Rosselló, Xavier; Sbarra, Pierluigi; Petitti, Elisabetta; Prever, Silvia Brach; Boccuzzi, Giacomo; D’Ascenzo, Fabrizio; Frea, Simone; Pidello, Stefano; Morici, Nuccia; Sacco, Alice; Oliva, Fabrizio; Valente, Serafina; Ferrari, Gaetano Maria De; Ugo, Fabrizio; Rametta, Francesco; Attisani, Matteo; Zanini, Paola; Noussan, Patrizia; Iannaccone, Mario

doi:10.1016/j.jcrc.2022.154024

Cited by 31 publications

(20 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Interestingly, patients with CS that received an early pulmonary artery catheter (PAC) prior to MCS had improved short-term mortality and overall survival rates compared to patients without a PAC. This was also associated with lower incidence of short-term mortality, particularly in advanced CS (31,32). Moreover, PAC-derived hemodynamic parameters such as CPO, pulmonary artery pulsatility index (PAPi), or CVP/PCWP ratio have been used to assess RV function, LV filling status, and guide treatment after Impella implantation.…”

Section: Discussionmentioning

confidence: 99%

Single center experience and early outcomes of Impella 5.5

Funamoto

Kunavarapu²,

Kwan³

et al. 2023

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

BackgroundAcute decompensated heart failure (HF) and cardiogenic shock (CS) frequently are refractory to conservative treatment and require mechanical circulatory support (MCS). We report our early clinical experience and evaluate patient outcomes with the newer generation surgical Impella 5.5.MethodsSeventy patients that underwent Impella 5.5 implantation between October 2019 and December 2021 at a single center were enrolled in this study. Pre-operative characteristics, peri-operative clinical course information, and post-operative outcomes were retrospectively collected.ResultsFifty-seven (81%) patients survived to discharge, and 51 (76%) patients survived at the time of the first 30 days post-discharge visit. Thirty-one patients (44%) received Impella support for a bridge to advanced surgical heart failure therapy (transplant or durable left ventricular assist device [LVAD]), 27 (39%) cases were used for a bridge to recovery/decision and 12 (17.1%) cases was used for planned perioperative support for high-risk cardiac surgery procedure.ConclusionOur results suggest that Impella 5.5 provides favorable survival in the management of HF and CS, particularly used for a bridge to heart transplant or LVAD. Early extubation and mobilization with high flow circulatory support allowed effective tailoring of MCS approaches from peri-operative support for high-risk cardiac surgery, bridge to recovery, and to advanced surgical heart failure therapy.

show abstract

Section: Discussionmentioning

confidence: 99%

Single center experience and early outcomes of Impella 5.5

Funamoto

Kunavarapu²,

Kwan³

et al. 2023

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

show abstract

“…In the meta-analysis conducted by Chow et al , one article reporting on postcardiotomy shock was highly weighted despite its small sample size, and this may have contributed disproportionately to the overall findings and conclusions, pushing the trend toward a more positive effect. Bertaina et al also conducted a meta-analysis demonstrating the positive role of PAC in the management of CS ( 27 ). However, they analyzed only six articles, and there was a possibility of selection bias.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of pulmonary artery catheter monitoring for patients with cardiogenic shock of various causes: a systematic review and meta-analysis

Lee¹,

Lee²,

Kim³

et al. 2023

J Thorac Dis

View full text Add to dashboard Cite

Background: Cardiogenic shock is associated with significant morbidity and mortality. Invasive hemodynamic monitoring with pulmonary artery catheterization (PAC) can be useful in the assessment of changes in cardiac function and hemodynamic status; however, the benefits of PAC in the management of cardiogenic shock are not known well.Methods: We performed a systematic review and meta-analysis of observational studies and randomized controlled trials, comparing in-hospital mortality between PAC and non-PAC groups of cardiogenic shock patients with various underlying causes. Articles were obtained from MEDLINE, Embase, and Cochrane CENTRAL. We reviewed titles, abstracts, and full articles and evaluated the quality of evidence using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework. We used a random-effects model to compare studies in terms of in-hospital mortality findings. Results:We included twelve articles in our meta-analysis. Mortality among patients with cardiogenic shock was not significantly different between the PAC and the non-PAC groups [risk ratio (RR) 0.86, 95% confidence interval (CI): 0.73-1.02, I 2 =100%, P<0.01]. Two studies investigating cardiogenic shock caused by acute decompensated heart failure determined lower in-hospital mortality in the PAC group than in the non-PAC group (RR 0.49, 95% CI: 0.28-0.87, I 2 =45%, P=0.18). Six studies investigating cardiogenic shock of any cause determined lower in-hospital mortality in the PAC group than in the non-PAC group (RR 0.84, 95% CI: 0.72-0.97, I 2 =99%, P<0.01). There was no significant difference in in-hospital mortality between the PAC and non-PAC groups of patients with cardiogenic shock secondary to acute coronary syndrome (RR 1.01, 95% CI: 0.81-1.25, I 2 =99%, P<0.01).Conclusions: Overall, our meta-analysis demonstrated no significant association between PAC monitoring and in-hospital mortality among patients managed for cardiogenic shock. The use of PAC in the management of cardiogenic shock caused by acute decompensated heart failure was associated with lower inhospital mortality, but there was no association between PAC monitoring and in-hospital mortality among patients with cardiogenic shock caused by acute coronary syndrome.

show abstract

“…Another meta-analysis of six observational studies comparing PAC use vs. no PAC in cardiogenic shock also reported a reduction in short-term mortality in the PAC-managed patients (36% [95% CI 27-45%] vs. 47% [95% CI 35-59%]; adjusted odds ratio 0.71, 95% CI 0.59-0.87, P < 0.01) [35].…”

Section: Recent Studies Comparing Outcomes In Patients With and Witho...mentioning

confidence: 94%

The pulmonary artery catheter

Arias-Ortiz

Vincent

2023

Current Opinion in Critical Care

View full text Add to dashboard Cite

Purpose of reviewTo review recently published data on pulmonary artery catheter (PAC) use in critically ill patients and consider optimal use of the PAC in personalized clinical practice.Recent findingsAlthough PAC use has decreased considerably since the mid-1990s, PAC-derived variables can still have an important role in elucidating hemodynamic status and directing management in complex patients. Recent studies have suggested benefit, notably in patients having cardiac surgery.SummaryOnly a small number of acutely ill patients require a PAC and insertion should be individualized based on clinical context, availability of trained staff, and the possibility that measured variables will be able to help guide therapy.

show abstract

Prognostic implications of pulmonary artery catheter monitoring in patients with cardiogenic shock: A systematic review and meta-analysis of observational studies

Cited by 31 publications

References 29 publications

Single center experience and early outcomes of Impella 5.5

Single center experience and early outcomes of Impella 5.5

Effectiveness of pulmonary artery catheter monitoring for patients with cardiogenic shock of various causes: a systematic review and meta-analysis

The pulmonary artery catheter

Contact Info

Product

Resources

About