Patterns of temporary mechanical circulatory support, escalation, de-escalation and outcomes in cardiogenic shock

BACKGROUND: Cardiogenic Shock can affect significantly the survival in patients with AMI or ADHF.Mechanical circulatory support is the keystone of treatment beyond standard care to improve end organ perfusion and potentially survival.Hemodynamics progression during support has not been well studied. This retrospective cohort study aims to evaluate the patterns, timingand outcomes of therapeutic circulatory support escalation and de-escalation in patients admitted to a tertiary referral cardiogenic shockcenter.

METHODS: Data were collected for the patients over the age of 18 that had implantation of the microaxial flow pump at the University of Iowa HealthCare. Data includes invasive hemodynamics during admission, 24 h and 72 h post intervention along different modalities ofmechanical and pharmacological hemodynamic support in addition to patient history and baseline characteristics.

RESULTS: A total of 110 patients were included in the analysis, 53 patients (48.18%) survived. The average Impella power level was significantly lowerin the survival group (6.21 vs. 6.92, p=0.01) despite similar flow rates between groups (3.16 L/min vs. 3.08 L/min, p=0.31). 72 h Cardiacpower output was significantly better within survivors (1.15 watts vs. 0.69 watts, p<0.01). Multivariable logistic regression analysis identifiedelevated cardiac power at 72 h post intervention as an independent predictor of survival among patients with GCS during hospitalization(OR 0.09; 95% CI 0.02-0.45; p=0.03).

CONCLUSION: Our data indicate that sustained hemodynamic improvement, particularly in cardiac power output, is associated with survival, independently ofthe absolute changes in Impella flow and power.