TCT-754 Predictors of Mortality and Clinical Outcomes of Acute Severe Cardiogenic Shock Treated With the Impella® Device
Department
Analytics and Data Science Institute
Document Type
Article
Publication Date
9-25-2018
Abstract
Background The Impella® (Abiomed, Massachusetts) device has been increasingly used for mechanical circulatory support (MCS) in patients with acute severe cardiogenic shock (CS). Initial and continued determination of the appropriate degree of MCS is challenging. This study evaluates predictors of mortality in patients treated with the Impella® device for acute severe CS as well as outcomes associated with prolonged Impella® use (greater than 4 days). Methods All patients treated with the Impella® 2.5, CP, or 5.0 from 2011 to 2018 at our institution for hemodynamic support in the setting of acute severe CS (n=191) were included in this study. Medical records were reviewed for patient demographics, preimplantation hemodynamic and biochemical parameters, hospital stay details, and disposition. The primary endpoint was all-cause mortality, defined as in-hospital death during index hospitalization. Odds ratios were calculated for each hemodynamic and biochemical parameter via logistic regression in SAS® 9.4. Results One hundred and ninety-one patients (139 male, 52 female) received the Impella® (54 Impella® 2.5, 131 Impella® CP, 6 Impella® 5.0). All-cause mortality was 46%. When compared to survivors (n=104), nonsurvivors (n=87) had a lower initial pH (7.24 vs 7.33, odds ratio (OR) 1.06, p=0.001), lower initial serum CO2 (19.1 vs 21.3 mmol/L, OR 1.12, p=0.002), lower initial SvO2 (51.2 vs 60.7 mmol/L, OR 1.04, p=0.006), higher initial lactic acid (6.9 vs 3.2 mmol/L, OR 1.45, p<0.001), and used a greater number of vasopressors and inotropes (4.3 vs 2.6, OR 2.30, p<0.001). When compared to Impella® use ≤4 days (n=145), those with the Impella® >4 days (n=46) had increased mortality (58.7% vs 41.4%, p=0.04), required more vasopressors and inotropes (4.1 vs 3.1, p<0.001), had a longer ICU stay (12.1 vs 6.9 days, p<0.001), longer total hospital stay (15.8 vs 11.3 days, p=0.02), and longer use of mechanical ventilation (7.4 vs 4.5 days, p=0.003). Conclusion This study analyzes the largest known series of patients supported with the Impella® device for acute severe cardiogenic shock at a single center. In such patients, initial predictors of mortality were lower pH, lower CO2, lower SvO2, higher lactic acid, and greater number of vasopressors and inotropes used. These parameters can serve as valuable indicators in deciding whether an Impella® or higher level of initial support is more appropriate. Patients who have the Impella® device exceeding 4 days have poorer outcomes and may benefit from escalation of care.
Journal Title
Journal of the American College of Cardiology
Journal ISSN
0735-1097
Volume
72
Issue
13
First Page
B301
Digital Object Identifier (DOI)
10.1016/j.jacc.2018.08.1980