Abstract
Objective
This study sought to examine the trends and predictors of mechanical circulatory support
(MCS) use in patients hospitalized after out-of-hospital cardiac arrest (OHCA).
Background
There is a paucity of data regarding MCS use in patients hospitalized after OHCA.
Methods
We conducted an observational analysis of MCS use in 960,428 patients hospitalized
after OHCA between January 2008 and December 2014 in the Nationwide Inpatient Sample
database. On multivariable analysis, we also assessed factors associated with MCS
use and survival to discharge.
Results
Among the 960,428 patients, 51,863 (5.4%) had MCS utilized. Intra-aortic balloon pump
(IABP) was the most commonly used MCS after OHCA with frequency of 47,061 (4.9%),
followed by extracorporeal membrane oxygenation (ECMO) 3650 (0.4%), and percutaneous
ventricular assist devices (PVAD) 3265 (0.3%). From 2008 to 2014, there was an increase
in the utilization of MCS from 5% in 2008 to 5.7% in 2014 (P trend < 0.001). There was a non-significant decline in the use of IABP from 4.9% to 4.7%
(P trend = 0.95), whereas PVAD use increased from 0.04% to 0.7% (P trend < 0.001), and ECMO use increased from 0.1% to 0.7% (P trend < 0.001) during the study period. Younger, male patients with myocardial infarction,
higher co-morbid conditions, VT/VF as initial rhythm, and presentation to a large
urban hospital were more likely to receive percutaneous MCS implantation. Survival
to discharge was significantly higher in patients who were selected to receive MCS
(56.9% vs. 43.1%, OR: 1.16, 95% CI: (1.11–1.21), p < 0.001).
Conclusions
There is a steady increase in the use of MCS in OHCA, especially PVAD and ECMO, despite
lack of randomized clinical trial data supporting an improvement in outcomes. More
definitive randomized studies are needed to assess accurately the optimal role of
MCS in this patient population.
Abbreviations:
OHCA (out of hospital cardiac Arrest), MCS (mechanical circulatory support), PVAD (percutaneous ventricular assist device), ECMO (extra corporeal bypass with membrane oxygenator), CS (cardiogenic shock), VT (ventricular tachycardia), Vfib (ventricular fibrillation), PEA (pulseless electrical activity)Keywords
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Article info
Publication history
Published online: April 16, 2018
Accepted:
April 9,
2018
Received in revised form:
March 20,
2018
Received:
September 27,
2017
Footnotes
☆A Spanish translated version of the abstract of this article appears as Appendix in the final online version at https://doi.org/10.1016/j.resuscitation.2018.04.007.
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
