Abstract
Aims
To compare survival outcomes of Impella support and medical treatment in patients
with post-cardiac arrest cardiogenic shock related to acute myocardial infarction
(AMI).
Methods
Retrospective single center study of patients resuscitated from out of hospital cardiac
arrest (OHCA) due to AMI with post-cardiac arrest cardiogenic shock between September
2014 and September 2016. Patients were either assisted with Impella or received medical
treatment only. Survival outcomes were compared using propensity score-matched analysis
to account for differences in baseline characteristics between both groups.
Results
A total of 90 consecutive patients with post-cardiac arrest shock due to AMI were
included; 27 patients in the Impella group and 63 patients in the medical treatment
group. Patients with Impella support had a longer duration of low-flow time (29.54 ± 10.21
versus 17.57 ± 8.3 min, p < 0.001), higher lactate levels on admission (4.75 [IQR
3.8–11] versus 3.6 [IQR 2.6–3.9] mmol/L, p = 0.03) and lower baseline systolic LVEF
(25% [IQR 25–35] versus 45% [IQR 35–51.25], p < 0.001) as compared to patients without
circulatory support. After propensity score matching, patients with Impella support
had a significantly higher survival to hospital discharge (65% versus 20%, p = 0.01)
and 6-months survival (60% versus 20%, p = 0.02).
Conclusion
The results from our study suggest that Impella support is associated with significantly
better survival to hospital discharge and at 6 months compared to medical treatment
in OHCA patients admitted with post-cardiac arrest cardiogenic shock and AMI.
Keywords
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Article info
Publication history
Published online: March 06, 2018
Accepted:
March 5,
2018
Received in revised form:
January 10,
2018
Received:
September 17,
2017
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
