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• W2891182571 abstract "BackgroundIn the absence of robust evidence from randomized controlled trials, clinicians treating cardiogenic shock (CS) often make decisions on short-term Mechanical Circulatory Support (s-t MCS) based on individual center or clinical team preferences. We sought to investigate whether description of device-related adverse events (AE) could help identify targets to advance the field.MethodsOur institution's CS database was queried for CS patients who underwent placement of s-t MCS based on predefined criteria, between Jan 2014 - Mar 2017. Patients who needed Intra-Aortic Balloon Pump, central cannulation or had a post-cardiotomy CS were excluded from the analysis. We identified 61 who required s-t MCS with Impella, peripheral Veno-Arterial Extra-Corporeal Membrane Oxygenation (VA-ECMO) or combination of these devices as a sequela of escalating support strategy.ResultsOf the total patients, 23 (37.7%) were treated with Impella, 10 (16.4%) with VA-ECMO and the remaining 28 (45.9%) with combinations of devices. Groups were of similar demographics and CS etiology. Severity of CS pre-MCS revealed no differences in vital signs, number of vasoactive agents used, left ventricular ejection fraction, use of mechanical ventilation and CPR. The VA-ECMO compared with Impella and Combination groups had higher baseline lactate (11.1 vs 4.9 vs 5.3; p=0.002) and lower baseline pH (7.05 vs 7.27 vs 7.27; p=0.004) pre-MCS. The mean length of support was similar between Impella and VA-ECMO groups, however it was longer in the Combination vs Impella group (p=0.001). Major AE are shown in the Table. The mean ICU stay was 15 days and did not differ among the groups. Exchange to durable LVAD was performed in 6 patients: 3/23 (Impella) and 3/28 (Combination) group. The overall survival to hospital discharge was 43% and did not differ between the groups (p=0.2).ConclusionsDespite significant advances in the technology of s-t MCS options, morbidity and mortality remain high and the device-related AE could provide practical quality improvement targets for CS programs. In the absence of robust evidence from randomized controlled trials, clinicians treating cardiogenic shock (CS) often make decisions on short-term Mechanical Circulatory Support (s-t MCS) based on individual center or clinical team preferences. We sought to investigate whether description of device-related adverse events (AE) could help identify targets to advance the field. Our institution's CS database was queried for CS patients who underwent placement of s-t MCS based on predefined criteria, between Jan 2014 - Mar 2017. Patients who needed Intra-Aortic Balloon Pump, central cannulation or had a post-cardiotomy CS were excluded from the analysis. We identified 61 who required s-t MCS with Impella, peripheral Veno-Arterial Extra-Corporeal Membrane Oxygenation (VA-ECMO) or combination of these devices as a sequela of escalating support strategy. Of the total patients, 23 (37.7%) were treated with Impella, 10 (16.4%) with VA-ECMO and the remaining 28 (45.9%) with combinations of devices. Groups were of similar demographics and CS etiology. Severity of CS pre-MCS revealed no differences in vital signs, number of vasoactive agents used, left ventricular ejection fraction, use of mechanical ventilation and CPR. The VA-ECMO compared with Impella and Combination groups had higher baseline lactate (11.1 vs 4.9 vs 5.3; p=0.002) and lower baseline pH (7.05 vs 7.27 vs 7.27; p=0.004) pre-MCS. The mean length of support was similar between Impella and VA-ECMO groups, however it was longer in the Combination vs Impella group (p=0.001). Major AE are shown in the Table. The mean ICU stay was 15 days and did not differ among the groups. Exchange to durable LVAD was performed in 6 patients: 3/23 (Impella) and 3/28 (Combination) group. The overall survival to hospital discharge was 43% and did not differ between the groups (p=0.2). Despite significant advances in the technology of s-t MCS options, morbidity and mortality remain high and the device-related AE could provide practical quality improvement targets for CS programs." @default.
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• W2891182571 date "2018-08-01" @default.
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• W2891182571 title "Cardiogenic Shock and Short-Term Mechanical Circulatory Support Options in the Current Era: Focus on Adverse Events" @default.
• W2891182571 doi "https://doi.org/10.1016/j.cardfail.2018.07.454" @default.
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