scholarly journals Association between serum lactate levels and mortality in patients with cardiogenic shock receiving mechanical circulatory support: a multicenter retrospective cohort study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Fernando Luís Scolari ◽  
Daniel Schneider ◽  
Débora Vacaro Fogazzi ◽  
Miguel Gus ◽  
Marciane Maria Rover ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Prognostic Value ◽  
Mechanical Circulatory Support ◽  
Lactate Clearance ◽  
Serum Lactate ◽  
Circulatory Support ◽  
Term Survival ◽  
Time Points ◽  
Lactate Levels ◽  
Va Ecmo

Abstract Background To evaluate the prognostic value of peak serum lactate and lactate clearance at several time points in cardiogenic shock treated with temporary mechanical circulatory support (MCS) using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) or Impella CP®. Methods Serum lactate and clearance were measured before MCS and at 1 h, 6 h, 12 h, and 24 h post-MCS in 43 patients at four tertiary-care centers in Southern Brazil. Prognostic value was assessed by univariable and multivariable analysis and receiver operating characteristic (ROC) curves for 30-day mortality. Results VA-ECMO was the most common MCS modality (58%). Serum lactate levels at all time points and lactate clearance after 6 h were associated with mortality on unadjusted and adjusted analyses. Lactate levels were higher in non-survivors at 6 h, 12 h, and 24 h after MCS. Serum lactate > 1.55 mmol/L at 24 h was the best single prognostic marker of 30-day mortality [area under the ROC curve = 0.81 (0.67–0.94); positive predictive value = 86%). Failure to improve serum lactate after 24 h was associated with 100% mortality. Conclusions Serum lactate was an important prognostic biomarker in cardiogenic shock treated with temporary MCS. Serum lactate and lactate clearance at 24 h were the strongest independent predictors of short-term survival.

scholarly journals Association between serum lactate levels and mortality in patients with cardiogenic shock receiving mechanical circulatory support: a multicenter retrospective cohort study

2020 ◽  
Author(s):  
Fernando Scolari ◽  
Daniel Schneider ◽  
Débora Vacaro Fogazzi ◽  
Miguel Gus ◽  
Marciane Maria Rover ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Prognostic Value ◽  
Mechanical Circulatory Support ◽  
Lactate Clearance ◽  
Serum Lactate ◽  
Circulatory Support ◽  
Term Survival ◽  
Time Points ◽  
Lactate Levels ◽  
Va Ecmo

Abstract Background: To evaluate the prognostic value of peak serum lactate and lactate clearance at several time points in cardiogenic shock treated with temporary mechanical circulatory support (MCS) using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) or Impella CP®.Methods: Serum lactate and clearance were measured before MCS and at 1h, 6h, 12h, and 24h post-MCS in 43 patients at four tertiary-care centers in Southern Brazil. Prognostic value was assessed by univariable and multivariable analysis and receiver operating characteristic (ROC) curves for 30-day mortality.Results: VA-ECMO was the most common MCS modality (58%). Serum lactate levels at all time points and lactate clearance after 6h were associated with mortality on unadjusted and adjusted analyses. Lactate levels were higher in non-survivors at 6h, 12h, and 24h after MCS. Serum lactate > 1.55 mmol/L at 24h was the best single prognostic marker of 30-day mortality [area under the ROC curve = 0.81 (0.67-0.94); positive predictive value = 86%). Failure to improve serum lactate after 24h was associated with 100% mortality.Conclusions: Serum lactate was an important prognostic biomarker in cardiogenic shock treated with temporary MCS. Serum lactate and lactate clearance at 24h were the strongest independent predictors of short-term survival.

scholarly journals Association between serum lactate levels and mortality in patients with cardiogenic shock receiving mechanical circulatory support: a multicenter retrospective cohort study

2020 ◽  
Author(s):  
Fernando Scolari ◽  
Daniel Schneider ◽  
Débora Vacaro Fogazzi ◽  
Miguel Gus ◽  
Marciane Maria Rover ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Prognostic Value ◽  
Mechanical Circulatory Support ◽  
Lactate Clearance ◽  
Serum Lactate ◽  
Circulatory Support ◽  
Term Survival ◽  
Time Points ◽  
Lactate Levels ◽  
Va Ecmo

Abstract Background: To evaluate the prognostic value of peak serum lactate and lactate clearance at several time points in cardiogenic shock treated with temporary mechanical circulatory support (MCS) using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) or Impella CP®.Methods: Serum lactate and clearance were measured before MCS and at 1h, 6h, 12h, and 24h post-MCS in 43 patients at four tertiary-care centers in Southern Brazil. Prognostic value was assessed by univariable and multivariable analysis and receiver operating characteristic (ROC) curves for 30-day mortality.Results: VA-ECMO was the most common MCS modality (58%). Serum lactate levels at all time points and lactate clearance after 6h were associated with mortality on unadjusted and adjusted analyses. Lactate levels were higher in non-survivors at 6h, 12h, and 24h after MCS. Serum lactate > 1.55 mmol/L at 24h was the best single prognostic marker of 30-day mortality [area under the ROC curve = 0.81 (0.67-0.94); positive predictive value = 86%). Failure to improve serum lactate after 24h was associated with 100% mortality.Conclusions: Serum lactate was an important prognostic biomarker in cardiogenic shock treated with temporary MCS. Serum lactate and lactate clearance at 24h were the strongest independent predictors of short-term survival.

scholarly journals The usefulness of Veno-Arterial Extracorporeal Membranous Oxygenation in Patients with Cardiogenic Shock

2019 ◽  
Vol 7 (11) ◽  
pp. 1768-1773
Author(s):  
Mohamed Abouelwafa ◽  
Waheed Radwan ◽  
Alia Abdelfattah ◽  
Akram Abdelbary ◽  
Mohamed Khaled ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Serum Lactate ◽  
Base Deficit ◽  
Ecmo Support ◽  
Circulatory Support ◽  
Arterial Blood ◽  
Va Ecmo

BACKGROUND: Venoarterial extracorporeal membranous oxygenation is a form of temporary mechanical circulatory support that gets as a salvage technique in patients with cardiogenic shock, we intended to evaluate the effect of (VA ECMO) support on hemodynamics and lactate levels in patients with cardiogenic shock.AIM: The aim of our study is to detect the ability to introduce veno-arterial extracorporeal membranous oxygenation (VA ECMO) as a temporary extracorporeal life support system (ECLS) in our unit, demonstrate the role of ECMO in cardiogenic shock patients regarding improving hemodynamics and microcirculation, and demonstrate the complications and drawbacks in our first center experience regarding VA ECMO.MATERIAL AND METHODS: This was a single-centre observational study that included 10 patients admitted with cardiogenic shock for which VA ECMO was used as mechanical circulatory support. RESULTS: The MAP increased after initiation of the support. It was 41.8 ± 9.3 mmHg and 59.5 ± 6.8 mmHg (P = 0.005). The use of VA ECMO support was associated with a statistically significant decrease in the base deficit (-10.6 ± 4.2 and -6.3 ± 7.4, P = 0.038). The serum lactate declined from 5.9 ± 3.5 mmoL/L to 0.6 ± 4.4 mmoL/L by the use of VA ECMO; a statistically significant change (P = 0.005).CONCLUSIONS: We concluded that VA ECMO as mechanical support for patients with cardiogenic shock might improve mean arterial blood pressure, base deficit and lactate clearance.

scholarly journals Increasing use of the Impella®-pump in severe cardiogenic shock: a word of caution

2020 ◽  
Vol 30 (5) ◽  
pp. 711-714
Author(s):  
Sergey Vasin ◽  
Alois Philipp ◽  
Bernhard Floerchinger ◽  
Priyank Rastogi ◽  
Dirk Lunz ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Case Series ◽  
Contralateral Side ◽  
Serum Lactate ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Circulatory Support ◽  
Pressure Amplitude ◽  
Lactate Levels ◽  
Va Ecmo

Abstract Impella® pumps are increasingly utilized in patients in cardiogenic shock. We report on a case series where Impella support was insufficient, and a switch to venoarterial extracorporeal membrane oxygenation (VA ECMO) became necessary. ECMO patients with previous Impella devices were identified utilizing our institutional ECMO database. Since 2014, 10 patients with a mean age of 62 ± 3 years were identified. Despite correct placement of all Impella pumps, cardiogenic shock persisted with progressive multi-organ failure (Impella type 2.5/CP n = 6/4 patients). Femoro-femoral VA ECMO was implanted percutaneously on the contralateral side with the Impella initially left on standby but retracted into the descending aorta for transport reasons after a mean support time of 20 ± 8 h. All patients were able to unload their heart by left ventricular ejection with a blood pressure amplitude of 15 ± 3 mmHg on VA ECMO support. After VA ECMO implantation haemodynamic parameters improved significantly within 24 h of support (mean serum lactate levels decreased from 92 ± 17 to 44 ± 10 mg/dl, P = 0.031). Survival to hospital discharge was 70%. These data indicate that the Impella 2.5® and CP® might not be sufficient in profound cardiogenic shock. Comparative studies are necessary to specify which patient population benefits from which type of circulatory support.

scholarly journals Mechanical circulatory support with impella in patients with non-acute myocardial infarction related cardiogenic shock

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Haurand ◽  
S Bueter ◽  
C Jung ◽  
M Kelm ◽  
R Westenfeld ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Apache Ii Score ◽  
Hemodynamic Parameters ◽  
Clinical Scores ◽  
Lactate Levels

Abstract Background Percutaneous left ventricular assist devices such as the Impella pump, are used to hemodynamically stabilize patients with cardiogenic shock (CS) caused by acute myocardial infarction (AMI) until cardiac function has recovered after revascularization. Whether Impella mechanical circulatory support (MCS) is effective in stabilizing patients with CS not caused by AMI has so far not been thoroughly investigated. Purpose The aim of this study is to analyze whether MCS with Impella is effective to stabilize patients with non-AMI related CS compared to patients with AMI related CS. Method We retrospectively analyzed 106 patients with CS and Impella support in the years from 2011 to 2018. Efficacy to stabilize the patient was assessed by laboratory values such as lactate, hemodynamic parameters and clinical scores. The difference in mortality was calculated with the Log-Rank-Test, comparing Kaplan-Meier curves. Results 36 patients suffered from non-AMI CS and in 70 patients CS was caused by AMI. Regarding the clinical scores and hemodynamic parameters, both groups were severely ill, with no significant difference in APACHE II score, with a mean score of 17.9 in the non-AMI group compared to 20.5 in the AMI-group (p=0.103), the SOFA score (mean score of 6.3 in non-AMI group vs 6.8 in AMI group, p=0.467) and cardiac index (mean CI of 1.9 l/min/m2 in non-AMI group vs 2.2 l/min/m2 in AMI group, p=0.176). There was a comparable mean decrease in lactate levels in both groups 48 hours after initiation of MCS, from initially 4.1 mmol/l to 1.7 mmol/l (p<0.001) in the non-AMI group and from initially 3.6 mmol/l to 2.2 mmol/l (p=0.025) in the AMI group. The non-ACS group exhibited a trend of lower mortality compared to the AMI group, with 47% in the non-AMI group and 57% in the AMI group (p=0.067). In multivariate analysis, age, lactate levels, cardiopulmonary resuscitation, low platelets and higher doses of inotropes and vasopressors were independent predictors for mortality. An upgrade to LVAD was performed for 22% of the non-AMI group and for 6% of the AMI group (p=0.020). Conclusion Impella support is effective to hemodynamically stabilize patients with non-AMI related CS. Therefore, MCS can be used as bridge to recovery or enables further treatment options as upgrade to longterm mechanical support devices. Funding Acknowledgement Type of funding source: None

scholarly journals Biventricular Unloading with Impella and Venoarterial Extracorporeal Membrane Oxygenation in Severe Refractory Cardiogenic Shock: Implications from the Combined Use of the Devices and Prognostic Risk Factors of Survival

2021 ◽  
Vol 10 (4) ◽  
pp. 747
Author(s):  
Georgios Chatzis ◽  
Styliani Syntila ◽  
Birgit Markus ◽  
Holger Ahrens ◽  
Nikolaos Patsalis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Risk Scores ◽  
Circulatory Support ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Refractory Cardiogenic Shock ◽  
Lactate Levels ◽  
Va Ecmo

Since mechanical circulatory support (MCS) devices have become integral component in the therapy of refractory cardiogenic shock (RCS), we identified 67 patients in biventricular support with Impella and venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO) for RCS between February 2013 and December 2019 and evaluated the risk factors of mortality in this setting. Mean age was 61.07 ± 10.7 and 54 (80.6%) patients were male. Main cause of RCS was acute myocardial infarction (AMI) (74.6%), while 44 (65.7%) were resuscitated prior to admission. The mean Simplified Acute Physiology Score II (SAPS II) and Sequential Organ Failure Assessment Score (SOFA) score on admission was 73.54 ± 16.03 and 12.25 ± 2.71, respectively, corresponding to an expected mortality of higher than 80%. Vasopressor doses and lactate levels were significantly decreased within 72 h on biventricular support (p < 0.05 for both). Overall, 17 (25.4%) patients were discharged to cardiac rehabilitation and 5 patients (7.5%) were bridged successfully to ventricular assist device implantation, leading to a total of 32.8% survival on hospital discharge. The 6-month survival was 31.3%. Lactate > 6 mmol/L, vasoactive score > 100 and pH < 7.26 on initiation of biventricular support, as well as Charlson comorbity index > 3 and prior resuscitation were independent predictors of survival. In conclusion, biventricular support with Impella and VA-ECMO in patients with RCS is feasible and efficient leading to a better survival than predicted through traditional risk scores, mainly via significant hemodynamic improvement and reduction in lactate levels.

Abstract 13425: Comparison Between Impella 5.0 and External Corporeal Left Ventricular Assist Device as a Bridge to Decision in Patients With Cardiogenic Shock

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Toru Kondo ◽  
Naoki Shibata ◽  
shingo kazama ◽  
Yuki Kimura ◽  
Hideo Oishi ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Assist Device ◽  
Ventricular Assist ◽  
Cardiac Recovery ◽  
Left Ventricular Assist ◽  
Bridge To Decision ◽  
Va Ecmo

Background: In cardiogenic shock refractory to medical treatment, choosing and changing mechanical circulatory support to stabilize hemodynamics until cardiac recovery or next treatment is a strategic cornerstone for improving the outcome. We aimed to clarify the differences in treatment course and outcome between Impella 5.0 and extracorporeal left ventricular assist device (eLVAD) in patients with cardiogenic shock refractory to medical therapy or other mechanical circulatory support. Methods: We performed a retrospective medical record review of consecutive patients who were treated with Impella 5.0 or eLVAD as a bridge to decision (BTD) at our medical center from December 2011 to January 2020. Results: A total of 26 patients (median age 40 years, 16 males) were analyzed. Of seven patients managed with Impella 5.0, one patients used Impella CP and four patients used peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) before Impella 5.0 implantation. On the other hand, of 19 patients managed with eLVAD, 11 patients used VA-ECMO before eLVAD implantation. In patients managed with Impella 5.0, Impella 5.0 was removed successfully in two patients (29%) and four patients (71%) underwent the operation for durable LVAD. In patients managed with eLVAD, eLVAD was successfully removed in three patients (16%), nine patients (47%) required durable LVAD, and seven patients (37%) died during eLVAD management. The period between implantation of Impella 5.0 or eLVAD to durable LVAD surgery was significantly shorter with Impella 5.0 (58 [38 - 95] vs. 235 [126 - 318] days, p=0.001). During durable LVAD implantation, cardiopulmonary bypass time was significantly shorter and a significantly smaller amount of red blood cells transfusion was required with Impella 5.0 (149 [125 - 182] vs. 192 [170 - 250] minutes, p=0.042; 7.0 [5.0 - 9.5] vs. 15.0 [10.0- 2.0] units, p=0.019, respectively). There were 4 massive stroke events in eLVAD, but no massive stroke events in Impella 5.0. In Impella 5.0. Conclusions: Impella 5.0 facilitates smoother management as a BTD and reduces surgical invasiveness during durable LVAD implantation. Impella 5.0 would be a more effective option for success to cardiac recovery or next therapy than eLVAD.

scholarly journals Mechanical circulatory support in refractory cardiogenic shock due to influenza virus-related myocarditis

2020 ◽  
Vol 56 (3) ◽  
pp. 2000925 ◽  
Author(s):  
Jan-Thorben Sieweke ◽  
Muharrem Akin ◽  
Sebastian Stetskamp ◽  
Christian Riehle ◽  
Danny Jonigk ◽  
...  
Keyword(s):  
Influenza Virus ◽  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Influenza Virus Infection ◽  
Axial Flow ◽  
Circulatory Support ◽  
Influenza B ◽  
Refractory Cardiogenic Shock ◽  
Va Ecmo ◽  
The Impact

BackgroundThere is scarce evidence for mechanical circulatory support (MCS) in patients with influenza-related myocarditis complicated by refractory cardiogenic shock (rCS). We sought to investigate the impact of MCS using combined veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and micro-axial flow pumps (the ECMELLA concept) in influenza-related myocarditis complicated by rCS.MethodsThis is a prospective, observational analysis from the single centre HAnnover Cardiac Unloading REgistry (HACURE) from two recent epidemic influenza seasons. We analysed patients with verified influenza-associated myocarditis complicated by rCS who were admitted to our intensive care unit (ICU) on MCS. Subsequently, we performed a propensity score (PS) matched analysis to patients with acute myocardial infarction (AMI) complicated by rCS and non-ischaemic cardiomyopathy (DCM) related rCS.ResultsWe describe a series of seven patients with rCS-complicated influenza-related myocarditis (mean age 56±10 years, 58% male, influenza A (n=2)/influenza B (n=5)). No patient had been vaccinated prior to the influenza season. MCS was provided using combined VA-ECMO and Impella micro-axial flow pump. In two patients with out-of-hospital cardiac arrest, VA-ECMO had been implanted for extracorporeal cardiopulmonary resuscitation. All patients died within 18 days of hospital admission. By PS-based comparison to patients with AMI- or DCM-related rCS and combined MCS, 30-day mortality was significantly higher in influenza-related rCS.ConclusionDespite initial stabilisation with combined MCS in patients with rCS-complicated influenza-related myocarditis, the detrimental course of shock could not be stopped and all patients died. Influenza virus infection potentially critically affects other organs besides the heart, leading to irreversible end-organ damage that MCS cannot compensate for and, therefore, results in a devastating outcome.

scholarly journals Percutaneous Coronary Intervention (PCI) Strategies under Hemodynamic Support for Cardiogenic Shock: A Single-Center Experience with Two Patients

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Talha Ahmed ◽  
Diljon Chahal ◽  
Ronson J. Madathil ◽  
David Kaczorowski ◽  
Anuj Gupta
Keyword(s):  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Coronary Intervention ◽  
Circulatory Support ◽  
Single Center ◽  
Hemodynamic Support ◽  
Single Center Experience ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Percutaneous Coronary ◽  
Va Ecmo

We describe two cases of profound cardiogenic shock complicating acute myocardial infarction (CSAMI) requiring mechanical circulatory support (MCS) with venoarterial extracorporeal membrane oxygenation (VA-ECMO) allowing complex, high-risk, and staged percutaneous interventions with successful decannulation but with unfortunate outcomes.

Venoarterial Extracorporeal Membrane Oxygenation in Cardiogenic Shock: Lifeline of Modern Day CICU

2019 ◽  
pp. 088506661989454
Author(s):  
Aniket S. Rali ◽  
Jonathan Chandler ◽  
Andrew Sauer ◽  
Michael A. Solomon ◽  
Zubair Shah
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Treatment Modalities ◽  
Circulatory Support ◽  
Steady Increase ◽  
Membrane Oxygenation ◽  
Cardiopulmonary Support ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Va Ecmo

Cardiogenic shock (CS) portends an extremely high mortality of nearly 50% during index hospitalization. Prompt diagnoses of CS, its underlying etiology, and efficient implementation of treatment modalities, including mechanical circulatory support (MCS), are critical especially in light of such high predicted mortality. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides the most comprehensive cardiopulmonary support in critically ill patients and hence has seen a steady increase in its utilization over the past decade. Hence, a good understanding of VA-ECMO, its role in treatment of CS, especially when compared with other temporary MCS devices, and its complications are vital for any critical care cardiologist. Our review of VA-ECMO aims to provide the same.

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