scholarly journals Clinical Characteristics and Predictors of In-hospital Mortality in Patients with Cardiogenic Shock: Results from the RESCUE Registry

2020 ◽  
Author(s):  
Jeong Hoon Yang ◽  
Ki Hong Choi ◽  
Young-Guk Ko ◽  
Chul-Min Ahn ◽  
Cheol Woong Yu ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Primary Outcome ◽  
Circulatory Support ◽  
Limited Data ◽  
Inotrope Score ◽  
High Utilization ◽  
Variable Analysis

Abstract Background: In the current era of mechanical circulatory support, limited data are available on prognosis of cardiogenic shock (CS) caused by various diseases. We investigated the characteristics and predictors of in-hospital mortality in Korean CS patients.Methods: The RESCUE study is a multi-center, retrospective and prospective registry of patients that presented with CS. Between January 2014 and December 2018, 1,247 patients with CS were enrolled from 12 major centers in Korea. The primary outcome was in-hospital mortality. Results: In-hospital mortality rate was 33.6%. The main causes of shock were ischemic heart disease (80.7%), dilated cardiomyopathy (6.1%), myocarditis (3.2%), and non-ischemic ventricular arrhythmia (2.5%). Vasopressors were used in 1081 patients (86.7%). The most frequently used vasopressor was dopamine (63.4%) followed by norepinephrine (57.3%). An intra-aortic balloon pump was used in 314 patients (25.2%) and extracorporeal membrane oxygenator in 496 patients (39.8%). In multi-variable analysis, age ≥70 years, cardiac arrest at presentation, vasoactive-inotrope score >80, continuous renal replacement therapy, and mechanical ventilator were independent predictors for in-hospital mortality.Conclusions: The in-hospital mortality of CS patients remains high despite the high utilization of mechanical circulatory support. Age, cardiac arrest at presentation, amount of vasopressor, and advanced organ failure were poor prognostic factors for in-hospital mortality.Trial registration: RESCUE registry, Clinicaltrials.gov, NCT02985008, Registered 01 January 2014 - Retrospectively and Prospectively registered https://clinicaltrials.gov/ct2/show/NCT02985008.

scholarly journals Impact of temporary mechanical circulatory support on mortality in cardiogenic shock: an emulated target trial with a prospective, multicenter, French cohort study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Ughetto ◽  
J Eliet ◽  
N Nagot ◽  
H David ◽  
F Bazalgette ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Circulatory Support ◽  
Control Group ◽  
Heart Team ◽  
Hospital Survival ◽  
Expert Center

Abstract Background The field of temporary mechanical circulatory support (TMCS) has advanced in last decade justifying that TMCS is increasingly used for treatment of refractory cardiogenic shock (CS). Nevertheless, the efficacy of TMCS (extracorporeal life support (ECLS) and Impella) in CS remains controversial due to the lack of high-quality evidence. The aim of this prospective multicenter observational study simulating a randomized trial was to assess the impact of TMCS on the hospital mortality in patients with CS. Methods This study (ClinicalTrials.gov ID: NCT03528291) was conducted at 3 TMCS centers organized in a cardiac assistance network, one as a level 1 TMCS center (expert center), and 2 as level 2 centers (hub centers). The study was designed and led by the heart team of the expert center with input from the hub centers. All patients admitted to an intensive care unit between July 2017 and May 2020 either directly at the TMCS centers or after transfer from a non-specialized hospital, were screened for TMCS indication provided they were admitted for CS. CS was defined according to the European Society of Cardiology criteria. Were excluded patients younger than 18 years, CS after cardiac surgery, or after cardiac arrest if it was refractory or with a no flow >3 min and/or out-of-hospital cardiac arrest with non-shockable rhythm, or CS in the context of myocardial infarction complications, massive pulmonary embolism, and if TMCS was contraindicated TMCS indication was decided after a multidisciplinary discussion carried out by the “heart team”. Implantation of TMCS resulted from an agreement of the heart team within the first 24 hours after admission mainly based on the initial severity of the CS, or if CS was refractory to the medical treatment. The primary outcome was in-hospital survival. A propensity score-weighted analysis was done for treatment-effect estimation. This method, which weights each patient according to their propensity score, includes all participants in the analysis. Results 246 patients with CS were included in the study: 121 in TMCS group (72% ECLS, 14% Impella, 14% both ECLS and Impella) and 125 in control group. After adjustment by a propensity score, hospital mortality was comparable in the two groups (32% TMCS group vs 27% control group; Odds ratio with TMCS, 1.28; 95% confidence interval, 0.87 to 1.88; p=0.21). Mortality at D180 was also similar in the two group (33% vs 30% respectively; p=0.51). Thromboembolic events were significantly higher in the TCMS group (14% vs 4%; p<0.01) as well as the transfusion rate ((median (IQR); 4.0 (0.0; 9.0) vs 0.0 (0.0; 0.0); p<0.01). Conclusion In our study, the use of TMCS does not seem to improve hospital survival in patients with cardiogenic shock. Thus, TMCS, which are iatrogenic side effects providers, should be reserved for the most severe patient and discussed by a multidisciplinary team. FUNDunding Acknowledgement Type of funding sources: None. Flow chart

scholarly journals Clinical Characteristics and Predictors of In-Hospital Mortality in Patients With Cardiogenic Shock: Results From the RESCUE Registry

2021 ◽  
Vol 14 (6) ◽  
Author(s):  
Jeong Hoon Yang ◽  
Ki Hong Choi ◽  
Young-Guk Ko ◽  
Chul-Min Ahn ◽  
Cheol Woong Yu ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Cardiac Arrest ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Circulatory Support ◽  
Intraaortic Balloon ◽  
Membrane Oxygenator ◽  
Intraaortic Balloon Pump ◽  
Extracorporeal Membrane Oxygenator

Background: In the current era of mechanical circulatory support, limited data are available on prognosis of cardiogenic shock (CS) caused by various diseases. We investigated the characteristics and predictors of in-hospital mortality in Korean patients with CS. Methods: The RESCUE study (Retrospective and Prospective Observational Study to Investigate Clinical Outcomes and Efficacy of Left Ventricular Assist Device for Korean Patients With CS) is a multicenter, retrospective, and prospective registry of patients that presented with CS. Between January 2014 and December 2018, 1247 patients with CS were enrolled from 12 major centers in Korea. The primary outcome was in-hospital mortality. Results: In-hospital mortality rate was 33.6%. The main causes of shock were ischemic heart disease (80.7%), dilated cardiomyopathy (6.1%), myocarditis (3.2%), and nonischemic ventricular arrhythmia (2.5%). Vasopressors were used in 1081 patients (86.7%). The most frequently used vasopressor was dopamine (63.4%) followed by norepinephrine (57.3%). An intraaortic balloon pump was used in 314 patients (25.2%) and extracorporeal membrane oxygenator in 496 patients (39.8%). In multivariable analysis, age ≥70years (odds ratio [OR], 2.73 [95% CI, 1.89–3.94], P <0.001), body mass index <25 kg/m 2 (OR, 1.52 [95% CI, 1.08–2.16], P =0.017), cardiac arrest at presentation (OR, 2.16 [95% CI, 1.44–3.23], P <0.001), vasoactive-inotrope score >80 (OR, 3.55 [95% CI, 2.54–4.95], P <0.001), requiring continuous renal replacement therapy (OR, 4.14 [95% CI, 2.88–5.95], P <0.001), mechanical ventilator (OR, 3.17 [95% CI, 2.16–4.63], P <0.001), intraaortic balloon pump (OR, 1.55 [95% CI, 1.07–2.24], P =0.020), and extracorporeal membrane oxygenator (OR, 1.85 [95% CI, 1.25–2.76], P =0.002) were independent predictors for in-hospital mortality. Conclusions: The in-hospital mortality of patients with CS remains high despite the high utilization of mechanical circulatory support. Age, low body mass index, cardiac arrest at presentation, amount of vasopressor, and advanced organ failure requiring various support devices were poor prognostic factors for in-hospital mortality. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02985008.

Abstract 15717: Impact of Mechanical Circulatory Support on Outcomes and In-hospital Mortality of Peripartum Cardiomyopathy Patients With Cardiogenic Shock: An Analysis of the Nis Database

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jennifer Maning ◽  
Bertrand Ebner ◽  
Louis Vincent ◽  
Jelani Grant ◽  
Sunita Mahabir ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Peripartum Cardiomyopathy ◽  
Circulatory Support ◽  
Significant Difference ◽  
Baseline Characteristics ◽  
Similar Survival ◽  
Stage Renal Disease ◽  
End Stage

Background: Peripartum cardiomyopathy (PPCM) is an uncommon form of cardiomyopathy that affects young women at the end of pregnancy or in the first few months following delivery, and is associated with increased morbidity and mortality. In selected patients with cardiogenic shock (CS), mechanical circulatory support (MCS) devices improve outcomes. However, data comparing outcomes of patients with PPCM who develop CS and receive mechanical circulatory support (MCS) vs. those treated medically remains limited. Methods: Using the National Inpatient Database (NIS) we identified patients with PPCM who were treated for CS from 2012 to 2017. Primary outcome was in-hospital mortality. Multivariate analysis models were adjusted for statistically significant differences in baseline characteristics between the groups. Results: A total of 4686 patients were admitted with a diagnosis of PPCM, of these 199 patients developed cardiogenic shock. Only 50 (25.1%) patients received MCS. Patients who received MCS were less likely to have a prior ICD in place (6% vs. 23%, p = 0.008), and were more likely to suffer from end-stage renal disease (6% vs. 0.67%, p = 0.020). There were no other major differences in baseline characteristics among the two groups. The incidence of ICD implant prior to discharge (4% vs. 7.4%, p = 0.243, OR 0.39) and cardiac arrest (16% vs. 7.4%, p = 0.173, OR 2.01) was not significantly different between the groups. There was no significant difference in in-hospital mortality between those who received MCS devices and those treated medically (22% vs 10.1%, p = 0.256, OR 1.73). LOS was longer for the MCS group (23.2% vs. 13.4 mean days, p = 0.001). Conclusions: The use of MCS in PPCM patients who developed cardiogenic shock appears to offer similar survival benefit compared to those treated medically, despite being associated with longer length of stay This finding may be related to the complexity and acuity level of patients receiving MCS compared to those treated medically.

scholarly journals Multidisciplinary approach and early use of percutaneous mechanical circulatory support devices in patients with cardiogenic shock

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Venuti ◽  
M Gramegna ◽  
L Baldetti ◽  
F Calvo ◽  
V Pazzanese ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mortality Rate ◽  
Adverse Events ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Multidisciplinary Approach ◽  
Circulatory Support ◽  
Coronary Syndrome ◽  
Early Use

Abstract Background Despite progresses in the reperfusion strategies, the prognosis of patients with cardiogenic shock (CS) remains poor with a high in-hospital mortality rate. Percutaneous mechanical circulatory support systems (pMCS) reducing afterload, preload and myocardial oxygen demand, preventing compensatory tachycardia and increasing mean arterial pressure, lead to improve end-organ perfusion. Since CS progression to a refractory shock state is deleterious, timing of treatment represents a crucial issue in these patients. Purpose The aim of our study was to assess whether a multidisciplinary approach and an early use of pMCS could be safe and effective in improving CS patients' outcome. Methods We examined the outcome in terms of one-month survival of 62 patients (75.8% males, mean age 67.7±12.2 years) admitted between January and December 2018 to our Cardiac Intensive Care Unit (CICU) with cardiogenic shock due to acute coronary syndrome (ACS), acute heart failure (AHF) and other causes in 43.5%, 21.6%, 35.4% of cases respectively. For each patient, a Multidisciplinary Shock Team (CS-Team) including critical care specialists, interventional cardiologists and advanced heart failure specialists, was involved and the early use of pMCS was considered. Results Overall, 52 (83.9%) CS patients underwent pMCS implant, including intra-aortic ballon pump counterpulsation (IABP), Impella system (Impella), venous-arterial extracorporeal membrane oxygenation (VA ECMO) in 67.7%, 46.7%, 11.3% of cases respectively. Median time from the first CS-Team contact to the pMCS implantation was 32.5 (30–60) minutes. Among ACS-CS group, AHF-CS group and CS-due to other causes group, pMCS were implanted in 25 (92.5%), 12 (92.3%) and 15 (68.1%) patients respectively. Lower extremities ischemia, gastrointestinal/intracerebral and life-threatening bleeding and ischemic stroke were observed as pMCS related adverse events in 9.7%, 6.4%, 1.6%, 3.2%, 6.4% of cases respectively. At one month, 56 (90.3%) CS patients were discharged alive while 6 (9.7%) CS patients died during the CICU stay. Conclusion A multidisciplinary approach of CS patients, contemplating an early and extensive use of pMCS, may be effective in the reduction of in-hospital mortality rate with a low and acceptable occurrence of pMCS related adverse events. Funding Acknowledgement Type of funding source: None

scholarly journals Clinical Outcomes Associated with Acute Mechanical Circulatory Support Utilization in Heart Failure Related Cardiogenic Shock

2021 ◽  
Author(s):  
Jaime Hernandez-Montfort ◽  
Shashank S. Sinha ◽  
Katherine L. Thayer ◽  
Evan H. Whitehead ◽  
Mohit Pahuja ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Clinical Outcomes ◽  
Mechanical Circulatory Support ◽  
Left Ventricular ◽  
Right Atrial ◽  
Circulatory Support ◽  
Hospital Death ◽  
Acute Mechanical Circulatory Support

Background : Cardiogenic shock occurring in the setting of advanced heart failure (HF-CS) is increasingly common. However, recent studies have focused almost exclusively on acute myocardial infarction related cardiogenic shock. We sought to define clinical, hemodynamic, metabolic, and treatment parameters associated with clinical outcomes among HF-CS patients, using data from the Cardiogenic Shock Working Group (CSWG) Registry. Methods : Patients with HF-CS were identified from the multi-center CSWG registry and divided into 3 outcome categories assessed at hospital discharge: mortality, heart replacement therapy (HRT: durable ventricular assist device [VAD] or orthotopic heart transplant [OHT]), or native heart survival (NHS). Clinical characteristics, hemodynamic, laboratory parameters, drug therapies, acute mechanical circulatory support device (AMCS) utilization, and Society of Cardiovascular Angiography and Intervention (SCAI) stages were compared across the 3 outcome cohorts. Results : Of the 712 HF-CS patients identified, 180 (25.3%) died during their index admission, 277 (38.9%) underwent HRT (durable VAD or OHT), and 255 (35.8%) experienced NHS without HRT. Patients who died had the highest right atrial pressure and heart rate and the lowest mean arterial pressure of the 3 outcome groups (p<0.01 for all). Biventricular and isolated left-ventricular congestion were common among patients who died or underwent HRT, respectively. Lactate, blood urea nitrogen, serum creatinine, and aspartate aminotransferase were highest in HF-CS patients experiencing in-hospital death. Intra-aortic balloon pump (IABP) was the most commonly used AMCS device in the overall cohort and among patients receiving HRT. Patients receiving more than one AMCS device had the highest in-hospital mortality rate irrespective of the number of vasoactive drugs used. Mortality decreased with deteriorating SCAI stages (stage B: 0%, stage C: 10.7%, stage D: 29.4%, stage E: 54.5%, 1-way ANOVA = <0.001). Conclusions : Patients with HF-CS experiencing in-hospital mortality had a high prevalence of biventricular congestion and markers of end-organ hypoperfusion. Substantial heterogeneity exists with use of AMCS in HF-CS with IABP being the most common device used and high rates of in-hospital mortality after exposure to more than one AMCS device.

Abstract 114: Mechanical Circulatory Support in Percutaneous Coronary Intervention: A Propensity-matched Analysis

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Rohan Khera ◽  
Peter Cram ◽  
Mary Vaughan-Sarrazin ◽  
Phillip A Horwitz ◽  
Saket Girotra
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Clinical Effectiveness ◽  
Coronary Intervention ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Percutaneous Coronary

Introduction: Percutaneous ventricular assist devices (PVAD) and intra-aortic balloon pump (IABP) are used to provide mechanical circulatory support for high-risk percutaneous coronary intervention (PCI). Due to limited evidence from randomized controlled trials, we compared clinical outcomes between PVAD and IABP in PCI patients using a propensity-matched analysis. Methods: Adult patients who underwent PCI during 2004-2012 and also received either a PVAD or an IABP on the same day as PCI were identified in the National Inpatient Sample using ICD9 procedure codes. We compared in-hospital mortality for PVAD vs. IABP using a 1:2 propensity-matched analysis - both overall and in subgroups with cardiogenic shock, AMI without cardiogenic shock and no cardiogenic shock or AMI. Results: We identified 5031 patients who received a PVAD and 122,333 who received an IABP on the same day as PCI. Patients who received PVAD were older (69 vs 65 years), more likely to be men (74% vs 69%), admitted electively (30% vs 11%) but less likely to have AMI (52% vs 90%), cardiogenic shock (23% vs 50%), cardiac arrest (12% vs 25%) or need mechanical ventilation (16% vs 29%) compared to IABP patients (P<0.001 for all). In contrast, prevalence of heart failure (68% vs 41%), valvular heart disease (22% vs 13%), chronic kidney disease (27% vs 11%), hypertension (71% vs 56%) and diabetes (46% vs 32%) was higher in PVAD recipients (P<0.001 for all). Unadjusted in-hospital mortality in PVAD recipients was lower compared to IABP patients - both overall (12.8% vs 20.9%, P<0.001) and in the cardiogenic shock subgroup (31% vs 38%, P=0.04) but was similar in patients without cardiogenic shock. After propensity-matching and successful balancing of covariates (figure) we found no difference in mortality in PVAD and IABP recipients (odds ratio [OR] 0.88, 95% CI 0.70-1.09). Our findings were also consistent among patients with cardiogenic shock (OR 1.37, 95% CI 0.99-1.90), AMI without cardiogenic shock (OR 0.72, 95% CI 0.46-1.14) and no cardiogenic shock or AMI (OR 0.54, 95% CI 0.27-1.06). Conclusion: The lower unadjusted mortality in patients undergoing PCI with PVAD support compared to IABP support may be due to selective use of PVADs in a lower risk population. Randomized trials are necessary to establish the clinical effectiveness of PVADs to support high-risk PCI.

Abstract 240: Concomitant Use of Therapeutic Hypothermia with Mechanical Circulatory Support in Patients Post Cardiac Arrest in Cardiogenic Shock: A Single Center Experience

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Michael G Silverman ◽  
Molly H O’Brien ◽  
Kathleen R Avery ◽  
Annmarie Chase ◽  
Carol D Pierce ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiogenic Shock ◽  
Clinical Outcomes ◽  
Hospital Discharge ◽  
Mechanical Circulatory Support ◽  
Care Center ◽  
Tertiary Care ◽  
Circulatory Support ◽  
Tertiary Care Center ◽  
Baseline Characteristics

Background: The concurrent use of therapeutic hypothermia (TH) following cardiac arrest and mechanical circulatory support (MCS) for cardiogenic shock is becoming increasingly common. Little is known however, about the combined use of TH and MCS for patients after ROSC following a cardiac arrest who remain in cardiogenic shock. Therefore we describe the experience with concomitant use of TH and MCS from a large academic tertiary care center in Boston. Methods: Baseline characteristics and clinical outcomes at hospital discharge were reported for patients undergoing TH following cardiac arrest who also received MCS for cardiogenic shock. MCS included Intra-aortic balloon pump (IABP) two percutaneous ventricular assist devices (Impella, and TandemHeart), and extracorporeal membrane oxygenation (ECMO). Clinical outcomes included mortality as well as cerebral performance category (CPC) at hospital discharge. Results: There were a total of 14 patients who underwent concomitant TH and MCS following a cardiac arrest. Baseline characteristics and clinical outcomes are noted in the Figure. 9 patients underwent placement of IABP, 2 patients an Impella pump, 2 patients a TandemHeart, and 1 patient ECMO. All 14 cardiac arrests were due to cardiovascular etiologies; 9 of 14 had STEMI. 9 of 14 patients had an initial shockable rhythm. Mean age was 56 years (+/- 19), mean downtime was 35 minutes (+/- 24). All patients were vasopressor dependent. Bleeding events are noted in the table. 8 patients survived to hospital discharge, all with good neurologic outcome. These rates were comparable to the survival rates and neurologic outcomes among 82 patients who underwent TH post cardiac arrest (from cardiovascular etiologies) without concomitant MCS (Figure). Conclusion: Based on our experience from a large academic tertiary care center, concomitant use of TH and MCS is both safe and feasible with an encouraging rate of cardiac and neurologic recovery.

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