Author + information
- Kevin Morine1,
- Michele Esposito1,
- Shiva Annamalai1,
- Robert Pedicini1,
- Lena Jorde1,
- Kyle Gobeil2,
- Jamie Hernandez-Montfort2 and
- Navin Kapur1
Clinical trials for acute mechanical circulatory support (AMCS) for cardiogenic shock (CS) have exclusively focused on patients with acute coronary syndrome (ACS). Outcomes for patients supported with AMCS for other indications have not been well-described.
We retrospectively analyzed all patients (n=140) between 2012-2016 receiving veno-arterial extra corporeal membrane oxygenation (VA-ECMO) (n=59) or Impella (n=81) for CS at two institutions.
The indications for AMCS were acute ACS (46%: STEMI 30% and NSTEMI 70%), acute decompensated heart failure (ADHF) (39%), myocarditis (8%) and post-cardiotomy CS (7%). Compared to VA-ECMO, Impella patients were older (59±14 vs. 54±12 years, all comparisons p<0.01) and more likely to have hypertension (57% vs. 24%). Impella patients had a lower lactate (3.3±2.7 vs. 7.1±5.8 mEq/L), higher pH (7.33±0.17 vs. 7.24±0.16) and higher MAP (72±15 vs. 61±15 mmHg) compared to VA-ECMO. The median duration of support was longer for VA-ECMO than Impella (7.4 days vs. 5 days, p=0.026). In-hospital mortality across indications was lower for Impella than VA-ECMO (40% vs. 59%, p=0.03; Figure). Compared to VA-ECMO, mortality was lower with Impella for ADHF (31% vs. 57%, p=0.037).
For patients with CS supported by AMCS, mortality is lower for patients supported with Impella, particularly for ADHF, although indices of CS severity are worse among VA-ECMO recipients. Investigation of outcome predictors for AMCS recipients is warranted.