Hemodynamic Support Provides Benefits in Cardiogenic Shock

November 2, 2016

Dramatic improvements in interventional techniques have produced advances in almost every aspect of cardiac care over the past decade. But one area has been a major challenge: In cardiogenic shock, mortality has remained high as incidence has gradually climbed.

Several factors appear to influence outcomes in patients with AMI complicated by cardiogenic shock who are treated with an Impella device, Dr. William O’Neill of the Henry Ford Hospital in Detroit, MI, reported at TCT 2016. He and his colleagues examined 287 cases from the cVAD registry, an international database that tracks all cardiogenic shock patients treated using Impella devices. The patients were treated with either the Impella 2.5™ or the Impella CP® devices.

Time to implantation was a major factor:  Survival fell from 66 percent among patients who received Impella less than 1.25 hours after shock onset, to 26 percent among those who received support after 4.25 hours or more. Patients were also more likely to survive if they were implanted before rather than after PCI. (M. Basir et al. J Am Coll Cardio. 2016:68(18_S):B49-B49)

 

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Patients who received Impella before PCI are shown in red; patients who received Impella after PCI in blue. (M. Basir et al. J Am Coll Cardio. 2016:68(18_S):B49-B49.)

The group studied was 76% male, with a mean age of 65.3 +/- 12.5 years and mean ejection fraction of 25.3 +/- 12.7 percent. Eighty percent required two or more inotropes before receiving Impella support, 52 percent had experienced cardiac arrest and 19 percent had anoxic brain injury. Survival to hospital discharge was 44 percent.

“These patients were in severe cardiogenic shock,” Dr. O’Neill said.  He noted that 30 percent of those who did not survive had neurologic damage, and 90 percent of non-survivors had received mechanical ventilation.

In studying a similarly ill group of patients, Dr. Joern Tongers of the Hannover Medical School in Germany and his colleagues studied the combined use of an Impella device and extracorporeal membrane oxygenation (ECMO) in cardiogenic shock.  In the single-site study, Dr. Tongers and his colleagues treated a group of 55 patients with both Impella and venoarterial ECMO.

Despite extremely poor prognoses — 93 percent required mechanical ventilation, 53 percent received dialysis and 38 percent had been resuscitated — the survival rate was 44 percent.

“Over the last years a whole host of technical opportunities to support or unload the ventricles have emerged,” Tongers concluded, “and it gives us a chance to secure patients.

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