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Clinical paper| Volume 127, P105-113, June 2018

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Trends in utilization of mechanical circulatory support in patients hospitalized after out-of-hospital cardiac arrest

      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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      References

        • Mozaffarian D.
        • Benjamin E.J.
        • Go A.S.
        • et al.
        American heart association statistics committee and stroke statistics subcommittee. Heart disease and stroke statistics–2015 update: a report from the American Heart Association.
        Circulation. 2015; 131: e29-322
        • Daya M.R.
        • Schmicker R.H.
        • Zive D.M.
        • et al.
        Out-of-hospital cardiac arrest survival improving over time: results from.
        Resuscitation. 2015; 91: 108-115
        • Disease Control C for Prevention
        • et al.
        Cardiac Arrest Registry to Enhance Survival (CARES), National Summary Report, 2014.
        2015
        • Kern K.B.
        • Hilwig R.W.
        • Rhee K.H.
        • Berg R.A.
        Myocardial dysfunction after resuscitation from cardiac arrest: an example of global myocardial stunning.
        J Am Coll Cardiol. 1996; 28: 232-240
        • Marwick T.H.
        • Case C.C.
        • Siskind V.
        • Woodhouse S.P.
        Prediction of survival from resuscitation: a prognostic index derived from multivariate logistic model analysis.
        Resuscitation. 1991; 22: 129-137
        • Kaji A.H.
        • Hanif A.M.
        • Thomas J.L.
        • Niemann J.T.
        Out-of-hospital cardiac arrest: early in-hospital hypotension versus out-of-hospital factors in predicting in-hospital mortality among those surviving to hospital admission.
        Resuscitation. 2011; 82: 1314-1317
        • Ostenfeld S.
        • Lindholm M.G.
        • Kjaergaard J.
        • et al.
        Prognostic implication of out-of-hospital cardiac arrest in patients with cardiogenic shock and acute myocardial infarction.
        Resuscitation. 2015; 87: 57-62
        • Kilgannon J.H.
        • Roberts B.W.
        • Jones A.E.
        • et al.
        Arterial blood pressure and neurologic outcome after resuscitation from cardiac arrest.
        Crit Care Med. 2014; 42: 2083-2091
        • Naidu S.S.
        Novel percutaneous cardiac assist devices: the science of and indications for hemodynamic support.
        Circulation. 2011; 123: 533-543
        • Kantrowitz A.
        • Tjonneland S.
        • Freed P.S.
        • et al.
        Initial clinical experience with intraaortic balloon pumping in cardiogenic shock.
        JAMA. 1968; 203: 113-118
        • Rastan A.J.
        • Dege A.
        • Mohr M.
        • et al.
        Early and late outcomes of 517 consecutive adult patients treated with extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock.
        J Thorac Cardiovasc Surg. 2010; 139 (311. e1): 302-311
      1. D. Burkhoff, W. O’Neill, C. Brunckhorst, et al., Feasibility study of the use of the TandemHeart® percutaneous ventricular assist device for treatment of cardiogenic shock. Catheter Cardiovasc Interv Wiley Subscription Services, Inc., A Wiley Company, 2006, 68 (August (2)), 211–7.

        • Kar B.
        • Gregoric I.D.
        • Basra S.S.
        • Idelchik G.M.
        • Loyalka P.
        The percutaneous ventricular assist device in severe refractory cardiogenic shock.
        J Am Coll Cardiol. 2011; 57: 688-696
        • O’Neill W.W.
        • Kleiman N.S.
        • Moses J.
        • et al.
        A prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: the PROTECT II study.
        Circulation. 2012; 126: 1717-1727
        • Rihal C.S.
        • Naidu S.S.
        • Givertz M.M.
        • et al.
        SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care (Endorsed by the American Heart Association, the Cardiological Society of India, and Sociedad Latino Americana de Cardiologia Intervencion; Affirmation of Value by the Canadian Association of Interventional Cardiology–Association Canadienne de Cardiologie d’intervention).
        J Card Fail. 2015; 21 (Elsevier): 499-518
      2. HCUP-US NIS Overview. [cited 2018]. Available at: https://www.hcup-us.ahrq.gov/nisoverview.jsp.

        • De Bruin M.L.
        • van Hemel N.M.
        • Leufkens H.G.M.
        • Hoes A.W.
        Hospital discharge diagnoses of ventricular arrhythmias and cardiac arrest were useful for epidemiologic research.
        J Clin Epidemiol. 2005; 58: 1325-1329
        • Patel N.
        • Patel N.J.
        • Macon C.J.
        • et al.
        Trends and outcomes of coronary angiography and percutaneous coronary intervention after out-of-hospital cardiac arrest associated with ventricular fibrillation or pulseless ventricular tachycardia.
        JAMA Cardiol. 2016; 1: 890-899
        • Johnson N.J.
        • Salhi R.A.
        • Abella B.S.
        • et al.
        Emergency department factors associated with survival after sudden cardiac arrest.
        Resuscitation. 2013; 84: 292-297
        • Khera R.
        • Angraal S.
        • Couch T.
        • et al.
        Adherence to methodological standards in research using the national inpatient sample.
        JAMA. 2017; 318: 2011-2018
        • Atkinson T.M.
        • Ohman E.M.
        • O’Neill W.W.
        • et al.
        A practical approach to mechanical circulatory support in patients undergoing percutaneous coronary intervention: an interventional perspective.
        JACC Cardiovasc Intervention. 2016; 9: 871-883
        • Stretch R.
        • Sauer C.M.
        • Yuh D.D.
        • Bonde P.
        National trends in the utilization of short-term mechanical circulatory support: incidence, outcomes, and cost analysis.
        J Am Coll Cardiol. 2014; 64: 1407-1415
        • Khera R.
        • Cram P.
        • Lu X.
        • et al.
        Trends in the use of percutaneous ventricular assist devices: analysis of national inpatient sample data, 2007 through 2012.
        JAMA Intern Med. 2015; 175: 941-950
        • Khera R.
        • Cram P.
        • Vaughan-Sarrazin M.
        • Horwitz P.A.
        • Girotra S.
        Use of mechanical circulatory support in percutaneous coronary intervention in the United States.
        Am J Cardiol. 2016; 117: 10-16
        • Thiagarajan R.R.
        • Brogan T.V.
        • Scheurer M.A.
        • et al.
        Extracorporeal membrane oxygenation to support cardiopulmonary resuscitation in adults.
        Ann Thorac Surg. 2009; 87: 778-785
        • Napp L.C.
        • Kühn C.
        • Hoeper M.M.
        • et al.
        Cannulation strategies for percutaneous extracorporeal membrane oxygenation in adults.
        Clin Res Cardiol. 2016; 105: 283-296
        • Callaway C.W.
        • Donnino M.W.
        • Fink E.L.
        • et al.
        Part 8: post-cardiac arrest care: 2015 american heart association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care.
        Circulation. 2015; 132: S465-82
        • Lin J.-W.
        • Wang M.-J.
        • Yu H.-Y.
        • et al.
        Comparing the survival between extracorporeal rescue and conventional resuscitation in adult in-hospital cardiac arrests: propensity analysis of three-year data.
        Resuscitation. 2010; 81: 796-803
        • Nagao K.
        • Hayashi N.
        • Kanmatsuse K.
        • et al.
        Cardiopulmonary cerebral resuscitation using emergency cardiopulmonary bypass, coronary reperfusion therapy and mild hypothermia in patients with cardiac arrest outside the hospital.
        J Am Coll Cardiol. 2000; 36: 776-783
        • Maekawa K.
        • Tanno K.
        • Hase M.
        • Mori K.
        • Asai Y.
        Extracorporeal cardiopulmonary resuscitation for patients with out-of-hospital cardiac arrest of cardiac origin: a propensity-matched study and predictor analysis.
        Crit Care Med. 2013; 41: 1186-1196
        • Stub D.
        • Bernard S.
        • Pellegrino V.
        • et al.
        Refractory cardiac arrest treated with mechanical CPR, hypothermia, ECMO and early reperfusion (the CHEER trial).
        Resuscitation. 2015; 86: 88-94
        • Sakamoto T.
        • Morimura N.
        • Nagao K.
        • et al.
        Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest: a prospective observational study.
        Resuscitation. 2014; 85: 762-768
        • Yannopoulos D.
        • Bartos J.A.
        • Raveendran G.
        • et al.
        Coronary artery disease in patients with out-of-hospital refractory ventricular fibrillation cardiac arrest.
        J Am Coll Cardiol. 2017; 70: 1109-1117
        • de Chambrun M.P.
        • Bréchot N.
        • Lebreton G.
        • et al.
        Venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock post-cardiac arrest.
        Intens Care Med. 2016; 42: 1999-2007
        • Bougouin W.
        • Aissaoui N.
        • Combes A.
        • et al.
        Post-cardiac arrest shock treated with veno-arterial extracorporeal membrane oxygenation: an observational study and propensity-score analysis.
        Resuscitation. 2017; 110: 126-132
        • Seyfarth M.
        • Sibbing D.
        • Bauer I.
        • et al.
        A randomized clinical trial to evaluate the safety and efficacy of a percutaneous left ventricular assist device versus intra-aortic balloon pumping for treatment of cardiogenic shock caused by myocardial infarction.
        J Am Coll Cardiol. 2008; 52: 1584-1588
        • Ouweneel D.M.
        • Eriksen E.
        • Sjauw K.D.
        • et al.
        Percutaneous mechanical circulatory support versus intra-aortic balloon pump in cardiogenic shock after acute myocardial infarction.
        J Am Coll Cardiol. 2017; 69: 278-287
        • Manzo-Silberman S.
        • Fichet J.
        • Mathonnet A.
        • et al.
        Percutaneous left ventricular assistance in post cardiac arrest shock: comparison of intra aortic blood pump and IMPELLA Recover LP2.5.
        Resuscitation. 2013; 84: 609-615
        • Thiele H.
        • Sick P.
        • Boudriot E.
        • et al.
        Randomized comparison of intra-aortic balloon support with a percutaneous left ventricular assist device in patients with revascularized acute myocardial infarction complicated by cardiogenic shock.
        Eur Heart J. 2005; 26: 1276-1283
        • Sandhu A.
        • McCoy L.A.
        • Negi S.I.
        • et al.
        Use of mechanical circulatory support in patients undergoing percutaneous coronary intervention: insights from the National Cardiovascular Data Registry.
        Circulation. 2015; 132: 1243-1251
        • Agarwal S.
        • Sud K.
        • Martin J.M.
        • Menon V.
        Trends in the use of mechanical circulatory support devices in patients presenting with ST-segment elevation myocardial infarction.
        JACC Cardiovasc Intervention. 2015; 8: 1772-1774