1
|
Modi SP, Hong Y, Sicke MM, Hess NR, Klass WJ, Ziegler LA, Rivosecchi RM, Hickey GW, Kaczorowski DJ, Ramanan R. Concomitant use of extracorporeal membrane oxygenation and percutaneous microaxial assist device support for cardiogenic shock. JTCVS Open 2024; 17:152-161. [PMID: 38420544 PMCID: PMC10897678 DOI: 10.1016/j.xjon.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/21/2023] [Accepted: 12/11/2023] [Indexed: 03/02/2024]
Abstract
Objectives Venoarterial extracorporeal membrane oxygenation (VA-ECMO) with concomitant percutaneous microaxial left ventricular assist device support is an emerging treatment modality for cardiogenic shock (CS). Survival outcomes by CS etiology with this support strategy have not been well described. Methods This study was a retrospective, single-center analysis of patients with CS due to acute myocardial infarction (AMI-CS) or decompensated heart failure (ADHF-CS) supported with VA-ECMO with concomitant percutaneous microaxial left ventricular assist device support from December 2020 to January 2023. Results A total of 44 patients were included (AMI-CS, n = 20, and ADHF-CS, n = 24). Patients with AMI-CS and ADHF-CS had similar survival at 90 days postdischarge (P = .267) with similar destinations after support (P = .220). Patients with AMI-CS initially supported with VA-ECMO were less likely to survive 90 days postdischarge (P = .038) when compared with other cohorts. Limb ischemia and acute kidney injury occurred more frequently in patients presenting with AMI-CS (P =.013; P = .030). Subanalysis of ADHF-CS patients into acute-on-chronic decompensated HF and de novo HF demonstrated no difference in survival or destination. Conclusions VA-ECMO with concomitant percutaneous microaxial left ventricular assist device support can be used to successfully manage patients with CS. There is no difference in survival or destination for AMI-CS and ADHF-CS with this support strategy. AMI-CS patients with initial VA-ECMO support have increased mortality in comparison to other cohorts. Future multicenter studies are required to fully analyze the differences between AMI-CS and ADHF-CS with this support strategy.
Collapse
Affiliation(s)
- Shan P. Modi
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Yeahwa Hong
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - McKenzie M. Sicke
- School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Nicholas R. Hess
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Wyatt J. Klass
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Luke A. Ziegler
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Ryan M. Rivosecchi
- Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Gavin W. Hickey
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - David J. Kaczorowski
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Raj Ramanan
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pa
| |
Collapse
|
2
|
Van Edom CJ, Gramegna M, Baldetti L, Beneduce A, Castelein T, Dauwe D, Frederiks P, Giustino G, Jacquemin M, Janssens SP, Panoulas VF, Pöss J, Rosenberg A, Schaubroeck HAI, Schrage B, Tavazzi G, Vanassche T, Vercaemst L, Vlasselaers D, Vranckx P, Belohlavek J, Gorog DA, Huber K, Mebazaa A, Meyns B, Pappalardo F, Scandroglio AM, Stone GW, Westermann D, Chieffo A, Price S, Vandenbriele C. Management of Bleeding and Hemolysis During Percutaneous Microaxial Flow Pump Support: A Practical Approach. JACC Cardiovasc Interv 2023; 16:1707-1720. [PMID: 37495347 DOI: 10.1016/j.jcin.2023.05.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/09/2023] [Accepted: 05/23/2023] [Indexed: 07/28/2023]
Abstract
Percutaneous ventricular assist devices (pVADs) are increasingly being used because of improved experience and availability. The Impella (Abiomed), a percutaneous microaxial, continuous-flow, short-term ventricular assist device, requires meticulous postimplantation management to avoid the 2 most frequent complications, namely, bleeding and hemolysis. A standardized approach to the prevention, detection, and treatment of these complications is mandatory to improve outcomes. The risk for hemolysis is mostly influenced by pump instability, resulting from patient- or device-related factors. Upfront echocardiographic assessment, frequent monitoring, and prompt intervention are essential. The precarious hemostatic balance during pVAD support results from the combination of a procoagulant state, due to critical illness and contact pathway activation, together with a variety of factors aggravating bleeding risk. Preventive strategies and appropriate management, adapted to the impact of the bleeding, are crucial. This review offers a guide to physicians to tackle these device-related complications in this critically ill pVAD-supported patient population.
Collapse
Affiliation(s)
- Charlotte J Van Edom
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Mario Gramegna
- Cardiac and Cardiac Surgery Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Baldetti
- Cardiac and Cardiac Surgery Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Beneduce
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Thomas Castelein
- Cardiovascular Center, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - Dieter Dauwe
- Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Pascal Frederiks
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Gennaro Giustino
- Department of Cardiology, The Zena & Michael A. Wiener Cardiovascular Institute, Mount Sinai, New York, New York
| | - Marc Jacquemin
- Department of Laboratory Medicine, University Hospitals of Leuven, Leuven, Belgium
| | - Stefan P Janssens
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Vasileios F Panoulas
- Departments of Cardiology and Critical Care, Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom; Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Janine Pöss
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
| | - Alexander Rosenberg
- Departments of Cardiology and Critical Care, Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom; Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | | | - Benedikt Schrage
- Department of Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Guido Tavazzi
- Anaesthesia and Intensive Care, Fondazione Policlinico San Matteo IRCCS, Pavia, Italy
| | - Thomas Vanassche
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Leen Vercaemst
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Dirk Vlasselaers
- Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Pascal Vranckx
- Department of Cardiology and Intensive Care Medicine, Jessa Ziekenhuis, Hasselt, Belgium
| | - Jan Belohlavek
- Second Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Diana A Gorog
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom; Postgraduate Medical School, University of Hertfordshire, Hertfordshire, United Kingdom
| | - Kurt Huber
- Departments of Cardiology and Intensive Care Medicine, Clinic Ottakring and Sigmund Freud University, Medical School, Vienna, Austria
| | - Alexandre Mebazaa
- Department of Anesthesiology and Critical Care and Burn Unit, Saint-Louis and Lariboisière Hospitals, Paris, France
| | - Bart Meyns
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Federico Pappalardo
- Cardiothoracic and Vascular Anesthesia and Intensive Care, Azienda Ospedaliera Nazionale Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Anna M Scandroglio
- Cardiac and Cardiac Surgery Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gregg W Stone
- Department of Cardiology, The Zena & Michael A. Wiener Cardiovascular Institute, Mount Sinai, New York, New York
| | - Dirk Westermann
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Susanna Price
- Departments of Cardiology and Critical Care, Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom; Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Christophe Vandenbriele
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium; Departments of Cardiology and Critical Care, Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
| |
Collapse
|
3
|
Kennel PJ, Lumish H, Kaku Y, Fried J, Kirtane AJ, Karmpaliotis D, Takayama H, Naka Y, Sayer G, Uriel N, Takeda K, Masoumi A. A case series analysis on the clinical experience of Impella 5.5® at a large tertiary care centre. ESC Heart Fail 2021; 8:3720-3725. [PMID: 34402210 PMCID: PMC8497328 DOI: 10.1002/ehf2.13512] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/09/2021] [Accepted: 07/04/2021] [Indexed: 11/06/2022] Open
Abstract
Aims We aimed to detail the early clinical experience with pVAD 5.5 at a large academic medical centre. Impella® 5.5 (Abiomed) is a temporary peripherally inserted left ventricular assist device (pVAD) used for the treatment of cardiogenic shock (CS). This system has several modifications aimed at improving deliverability and durability over the pVAD 5.0 system, but real‐world experience with this device remains limited. Methods and results We collected clinical and outcome data on all patients supported with pVAD 5.5 at our centre between February and December 2020, including procedural and device‐related complications. Fourteen patients with pVAD 5.5 were included. Aetiology of CS was acute myocardial infarction (n = 6), decompensated heart failure (n = 6), suspected myocarditis (n = 1), and post‐cardiotomy CS (n = 1). Four patients received pVAD 5.5 after being on inotropes alone, two were escalated from intra‐aortic balloon pump, two were escalated from pVAD CP, and six patients were transitioned to pVAD 5.5 from extracorporeal membrane oxygenation. Median duration of pVAD 5.5 support was 12 (interquartile range 7, 25) days. Complications included axillary insertion site haematoma (n = 3), acute kidney injury (n = 3), severe thrombocytopenia (n = 1), and stroke (n = 1). No valve injury or limb complications occurred. Survival to device explant for recovery or transition to another therapy was 11/14 (79%) patients. Conclusions In this early experience of the pVAD 5.5, procedural and device‐related complications were observed but were manageable, and overall survival was high in this critically ill cohort, particularly when the device was used as a bridge to other therapies.
Collapse
Affiliation(s)
- Peter J Kennel
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Heidi Lumish
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Yuji Kaku
- Division of Cardiothoracic Surgery, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Justin Fried
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Ajay J Kirtane
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 161 Fort Washington Avenue, New York, NY, 10032, USA.,Division of Cardiology, Cardiovascular Research Foundation, New York, NY, USA
| | - Dimitri Karmpaliotis
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Hiroo Takayama
- Division of Cardiothoracic Surgery, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Yoshifumi Naka
- Division of Cardiothoracic Surgery, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Gabriel Sayer
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Nir Uriel
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Koji Takeda
- Division of Cardiothoracic Surgery, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Amirali Masoumi
- Division of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, 161 Fort Washington Avenue, New York, NY, 10032, USA
| |
Collapse
|
4
|
Lang CN, Kaier K, Zotzmann V, Stachon P, Pottgiesser T, von Zur Muehlen C, Zehender M, Duerschmied D, Schmid B, Bode C, Wengenmayer T, Staudacher DL. Cardiogenic shock: incidence, survival and mechanical circulatory support usage 2007-2017-insights from a national registry. Clin Res Cardiol 2020; 110:1421-1430. [PMID: 33258007 PMCID: PMC8405485 DOI: 10.1007/s00392-020-01781-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/11/2020] [Indexed: 12/12/2022]
Abstract
Background A central element in the management of cardiogenic shock (CS) comprises mechanical circulatory support (MCS) systems to maintain cardiac output (CO). This study aims to quantify incidence, outcome and influence of MCS in CS over the last decade. Methods All patients hospitalized with CS in a tertiary university hospital in Germany between 2007 and 2017 were identified utilizing the international coding system ICD-10 with code R57.0. Application of MCS was identified via German procedure classification codes (OPS). Results 383,983 cases of cardiogenic shock were reported from 2007 to 2017. Patients had a mean age of 71 years and 38.5% were female. The incidence of CS rose by 65.6% from 26,828 cases in 2007 (33.1 per 100,000 person-years, hospital survival 39.2%) to 44,425 cases in 2017 (53.7 per 100,000 person-years, survival 41.2%). In 2007, 16.0% of patients with CS received MCS (4.6 per 100,000 person-years, survival 46.6%), dropping to 13.9% in 2017 (6.6 per 100,000 person-years, survival 38.6%). Type of MCS changed over the years, with decreasing use of the intra-aortic balloon pump (IABP), an increase in extracorporeal membrane oxygenation (VA-ECMO) and percutaneous ventricular assist device (pVAD) usage. Significant differences regarding in-hospital survival were observed between the devices (survival: overall: 40.2%; medical treatment = 39.5%; IABP = 49.5%; pVAD = 36.2%; VA-ECMO = 30.5%; p < 0.001). Conclusions The incidence of CS is increasing, but hospital survival remains low. MCS was used in a minority of patients, and the percentage of MCS usage in CS has decreased. The use rates of the competing devices change over time. Graphical Abstract ![]()
Electronic supplementary material The online version of this article (10.1007/s00392-020-01781-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Corinna N Lang
- Heart Center Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Klaus Kaier
- Faculty of Medicine, Institute for Medical Biometry and Statistics, University of Freiburg, Freiburg, Germany
| | - Viviane Zotzmann
- Heart Center Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Stachon
- Heart Center Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Torben Pottgiesser
- Heart Center Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Constantin von Zur Muehlen
- Heart Center Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Manfred Zehender
- Heart Center Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniel Duerschmied
- Heart Center Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bonaventura Schmid
- Department of Emergency Medicine, University Hospital of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Bode
- Heart Center Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tobias Wengenmayer
- Heart Center Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dawid L Staudacher
- Heart Center Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|