267: ECMO To Salvage Severe Cardiogenic Shock in Advanced Heart Failure and Transplantation

Abstract The treatment of patients with advanced acute heart failure is still challenging. Intra-aortic balloon pump (IABP) has widely been used in the management of patients with cardiogenic shock. However, according to international guidelines, its routinary use in patients with cardiogenic shock is not recommended. This recommendation is derived from the results of the IABP-SHOCK II trial, which demonstrated that IABP does not reduce all-cause mortality in patients with acute myocardial infarction and cardiogenic shock. The present position paper, released by the Italian Association of Hospital Cardiologists, reviews the available data derived from clinical studies. It also provides practical recommendations for the optimal use of IABP in the treatment of cardiogenic shock and advanced acute heart failure.

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Abstract 15170: In-hospital Utilization and Outcomes of Palliative Care Consultation in Patients With Advanced Heart Failure Complicated by Cardiogenic Shock Requiring Mechanical Circulatory Support

Circulation ◽

10.1161/circ.142.suppl_3.15170 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Jelani Grant ◽

Louis Vincent ◽

Bertrand Ebner ◽

Jennifer Maning ◽

Igor Vaz ◽

...

Keyword(s):

Heart Failure ◽

Palliative Care ◽

Cardiogenic Shock ◽

Mechanical Circulatory Support ◽

Life Experiences ◽

Advanced Heart Failure ◽

Circulatory Support ◽

High Morbidity ◽

Palliative Care Consultation ◽

Care Consultation

Introduction: Hospitalizations associated with advanced heart failure (HF) requiring mechanical circulatory support (MCS) are usually associated with a high morbidity, mortality and a protracted hospital course. Prior studies have shown that the early inclusion of palliative care specialist is associated with better end-of-life experiences. Methods: The National Inpatient Sample Database was queried from 2012 to 2017 for relevant International Classification of Diseases (ICD)-9 and ICD-10 procedural and diagnostic codes to identify patients above 18 years with advanced HF admitted with cardiogenic shock requiring MCS. Baseline characteristics and in-hospital outcomes were compared among patients evaluated by palliative care and those who were not. A p-value of <0.001 was considered statistically significant. Results: There were 748,360 patients hospitalized for advanced HF complicated by cardiogenic shock requiring MCS, of these a palliative care consult was placed in 118,015 (15.8%) patients. Patients evaluated by palliative care were older (70.6±14.9 vs. 64.9±16.3 years old, p<0.001) and had a higher prevalence of atrial fibrillation (39.3 vs. 35.1%,p<0.001) and chronic kidney disease (40.4 vs. 33.3, p<0.001), however had lower hypertension (57.4 vs. 59.7%, p<0.001), diabetes (35.4 vs. 36.5%, p<0.001), coronary artery disease (51.2 vs. 58.4%, p<0.001) and acute coronary syndromes (39.2 vs. 45.0%, p<0.001). Consulting palliative care was associated with a shorter length of stay (8.8±12.0 vs. 11.9±15.5 days, p<0.001), lower total hospital cost ($161,972±265,156 vs. $219,114±318,387, p<0.001) and higher Do Not Resuscitate (DNR) orders (30.8 vs. 5.8%, p<0.001). Mortality rates were higher in the palliative care cohort (73.4 vs. 29.4%, p<0.001). Conclusions: Despite the high morbidity and mortality associated with advanced HF patients with cardiogenic shock requiring MCS, the overall prevalence of palliative care consultation is exceedingly low. DNR orders were more prevalent in patients seen by the palliative care service. This study highlights the underutilization of palliative care services in this patient population, precluding any perceived benefit in end of life experiences.

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Revascularization in Cardiogenic Shock and Advanced Heart Failure

Current Treatment Options in Cardiovascular Medicine ◽

10.1007/s11936-019-0708-5 ◽

2019 ◽

Vol 21 (1) ◽

Author(s):

Youssef Rahban ◽

Carlos D. Davila ◽

Peter S. Natov ◽

Navin K. Kapur

Keyword(s):

Heart Failure ◽

Cardiogenic Shock ◽

Advanced Heart Failure

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Safety of Ultrasound-guided Bedside Swan-ganz Catheter Insertion In Advanced Heart Failure And Cardiogenic Shock

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2020.09.186 ◽

2020 ◽

Vol 26 (10) ◽

pp. S63

Author(s):

Alex T. Snyder ◽

Mark Moshiyakhov ◽

Pedram Kazemian ◽

Kulpreet Barn

Keyword(s):

Heart Failure ◽

Cardiogenic Shock ◽

Advanced Heart Failure ◽

Catheter Insertion ◽

Ultrasound Guided

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Mechanical Circulatory Support in Advanced Heart Failure

Indian Journal of Clinical Cardiology ◽

10.1177/26324636211032749 ◽

2021 ◽

pp. 263246362110327

Author(s):

Sonali Arora ◽

Auras R. Atreya

Keyword(s):

Heart Failure ◽

Cardiogenic Shock ◽

Heart Transplantation ◽

Medical Therapy ◽

Mechanical Circulatory Support ◽

Advanced Heart Failure ◽

Ventricular Assist Devices ◽

Circulatory Support ◽

Ventricular Assist ◽

Advanced Therapies

Advanced heart failure (HF) with persistent and progressive clinical decline despite maximal medical therapy portends a high mortality in the absence of advanced therapies, such as ventricular assist devices or heart transplantation. A subset of these advanced HF patients deteriorates into refractory cardiogenic shock, that is challenging to manage with vasoactive agents alone. Temporary mechanical circulatory support (MCS) device options have evolved over the years and provide a viable option to rescue and rest the myocardium of patients in cardiogenic shock. The goal of such therapy is to serve as bridge to recovery, or more often, a bridge to durable advanced therapies. For those patients with progressive advanced HF despite extensive medical therapy, durable MCS devices (ventricular assist devices) are available when heart transplantation is not feasible. In this article, we review currently available temporary and durable MCS devices, with a focus on their hemodynamic profiles, to inform optimal device selection for patients with advanced HF.

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