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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References
- Cardiogenic shock in intensive care units: evolution of prevalence, patient profile, management and outcomes, 1997–2012.Eur J Heart Fail. 2017; 19: 192-200https://doi.org/10.1002/ejhf.646
- Heart disease and stroke statistics–2015 update: a report from the American Heart Association.Circulation. 2015; 131: e29-322https://doi.org/10.1161/CIR.0000000000000152
- Global incidences of out-of-hospital cardiac arrest and survival rates: systematic review of 67 prospective studies.Resuscitation. 2010; 81: 1479-1487https://doi.org/10.1016/j.resuscitation.2010.08.006
- Trends in survival after in-hospital cardiac arrest.N Engl J Med. 2012; 367: 1912-1920https://doi.org/10.1056/NEJMoa1109148
- Cardiac resuscitation.N Engl J Med. 2001; 344: 1304-1313https://doi.org/10.1056/NEJM200104263441707
- Clinical practice. Neurologic prognosis after cardiac arrest.N Engl J Med. 2009; 361: 605-611https://doi.org/10.1056/NEJMcp0903466
- Reversible myocardial dysfunction in survivors of out-of-hospital cardiac arrest.Jac. 2002; 40: 2110-2116
- Intensive care unit mortality after cardiac arrest: the relative contribution of shock and brain injury in a large cohort.Intensive Care Med. 2013; 39: 1972-1980https://doi.org/10.1007/s00134-013-3043-4
- Left ventricular support by catheter-mounted axial flow pump reduces infarct size.Jac. 2003; 41: 1087-1095
- Mechanically unloading the left ventricle before coronary reperfusion reduces left ventricular wall stress and myocardial infarct size.Circulation. 2013; 128: 328-336https://doi.org/10.1161/CIRCULATIONAHA.112.000029
- Venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock post-cardiac arrest.Intensive Care Med. 2016; 42: 1999-2007https://doi.org/10.1007/s00134-016-4541-y
- Percutaneous left ventricular assistance in post cardiac arrest shock: comparison of intra aortic blood pump and IMPELLA Recover LP2.5.Resuscitation. 2013; 84: 609-615https://doi.org/10.1016/j.resuscitation.2012.10.001
- duration and survival of ventricular fibrillation in out-of-hospital cardiac arrest patients in sweden.Resuscitation. 2000; 44: 7-17
- Predictors of survival and favorable functional outcomes after an out-of-hospital cardiac arrest in patients systematically brought to a dedicated heart attack center (from the Harefield Cardiac Arrest Study).Am J Cardiol. 2015; 115: 730-737https://doi.org/10.1016/j.amjcard.2014.12.033
- Predictors for outcome among cardiac arrest patients: the importance of initial cardiac arrest rhythm versus time to return of spontaneous circulation, a retrospective cohort study.BMC Emerg Med. 2015; 15: 3https://doi.org/10.1186/s12873-015-0028-3
- Early predictors of poor outcome after out-of-hospital cardiac arrest.Crit Care. 2017; 21: 96https://doi.org/10.1186/s13054-017-1677-2
- Association of serum lactate with outcome after out-of-hospital cardiac arrest treated with therapeutic hypothermia.PLoS One. 2017; 12: e0173239https://doi.org/10.1371/journal.pone.0173239
- Cardiopulmonary resuscitation duration and survival in out-of-hospital cardiac arrest patients.Resuscitation. 2017; 111: 74-81https://doi.org/10.1016/j.resuscitation.2016.11.024
- SOFA score to assess the severity of the post-cardiac arrest syndrome.Resuscitation. 2016; 102: 110-115https://doi.org/10.1016/j.resuscitation.2016.03.001
- Percutaneous left-ventricular support with the Impella-2.5-assist device in acute cardiogenic shock: results of the Impella-EUROSHOCK-registry.Circ Heart Fail. 2013; 6: 23-30https://doi.org/10.1161/CIRCHEARTFAILURE.112.967224
- Impella CP versus intra-Aortic balloon pump in acute myocardial infarction complicated by cardiogenic shock: the IMPRESS trial.J Am Coll Cardiol. 2017; 69: 278-287https://doi.org/10.1016/j.jacc.2016.10.022
- Differences in the profile, treatment, and prognosis of patients with cardiogenic shock by myocardial infarction classification: a report from NCDR. Circulation.Cardiovascular Quality and Outcomes. 2013; 6: 708-715https://doi.org/10.1161/CIRCOUTCOMES.113.000262
- Factors associated with an increased chance of survival among patients suffering from an out-of-hospital cardiac arrest in a national perspective in Sweden.Am Heart J. 2005; 149: 61-66https://doi.org/10.1016/j.ahj.2004.07.014
- The current use of impella 2.5 in acute myocardial infarction complicated by cardiogenic shock: results from the USpella registry.J Interv Cardiol. 2014; 27: 1-11https://doi.org/10.1111/joic.12080
- Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on Resuscitation, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Asia, and the Resuscitation Council of Southern Africa); the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; and the Stroke Council. Circulation. 118. American Heart Association, Inc, 2008: 2452-2483https://doi.org/10.1161/CIRCULATIONAHA.108.190652
- Immediate percutaneous coronary intervention is associated with better survival after out-of-hospital cardiac arrest: insights from the PROCAT (Parisian Region Out of hospital Cardiac ArresT) registry.Circ Cardiovasc Interv. 2010; 3: 200-207https://doi.org/10.1161/CIRCINTERVENTIONS.109.913665
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.