Extracorporeal membrane oxygenation and microaxial left ventricular assist device in cardiogenic shock: Choosing the right mechanical circulatory support to improve outcomesCentral MessagePerspective
Objective: To evaluate the outcomes of patients supported with Impella (CP/5.0) or venoarterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock according to shock phenotype. The primary end point was 30-day survival. Methods: A retrospective study of patients supported with Impel...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-03-01
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| Series: | JTCVS Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666273623000098 |
| _version_ | 1797860369331388416 |
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| author | Olina Dagher, MD Pierre-Emmanuel Noly, MD, PhD Walid Ben Ali, MD, PhD Nadia Bouabdallaoui, MD, PhD Lucian Geicu, MD Roxanne Lamanna Pavan Malhi, BScN Elizabeth Romero Anique Ducharme, MD, MSc Philippe Demers, MD, MSc Yoan Lamarche, MD, MSc |
| author_facet | Olina Dagher, MD Pierre-Emmanuel Noly, MD, PhD Walid Ben Ali, MD, PhD Nadia Bouabdallaoui, MD, PhD Lucian Geicu, MD Roxanne Lamanna Pavan Malhi, BScN Elizabeth Romero Anique Ducharme, MD, MSc Philippe Demers, MD, MSc Yoan Lamarche, MD, MSc |
| author_sort | Olina Dagher, MD |
| collection | DOAJ |
| description | Objective: To evaluate the outcomes of patients supported with Impella (CP/5.0) or venoarterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock according to shock phenotype. The primary end point was 30-day survival. Methods: A retrospective study of patients supported with Impella (CP/5.0) or VA-ECMO between 2010 and 2020 was performed. Patients were grouped according to 1 of 2 shock phenotypes: isolated left ventricular (LV) dysfunction versus biventricular dysfunction or multiple organ failure (MOF). The local practice favors Impella for isolated LV dysfunction and VA-ECMO for biventricular dysfunction or MOF. Results: Among the 75 patients included, 17 (23%) had isolated LV dysfunction. Patients with biventricular dysfunction or MOF had a greater median lactate level compared with those with isolated LV dysfunction (7.9 [2.9-11.8] vs 3.8 [1.1-5.8] mmol/L, respectively). Among patients with isolated LV dysfunction, 30-day survival was 46% for the Impella group (n = 13) and 75% for VA-ECMO (n = 4). Among patients with biventricular dysfunction or MOF, 30-day survival was 9% for the Impella group (n = 11) and 28% for VA-ECMO (n = 47). Patients supported with Impella 5.0 had better 30-day survival compared with those supported with Impella CP, for both shock phenotypes (83% vs 14% and 14% vs 0%, respectively). Conclusions: In this small cohort, patients supported with Impella for isolated LV dysfunction and VA-ECMO for biventricular dysfunction or MOF had acceptable survival at 30 days. Patients with biventricular dysfunction or MOF who were supported by Impella had the lowest survival rates. Patients with isolated LV dysfunction who were supported with VA-ECMO had good 30-day survival. |
| first_indexed | 2024-04-09T21:44:45Z |
| format | Article |
| id | doaj.art-aa42c024a5cd4d14a12eafccc6246a52 |
| institution | Directory Open Access Journal |
| issn | 2666-2736 |
| language | English |
| last_indexed | 2024-04-09T21:44:45Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj.art-aa42c024a5cd4d14a12eafccc6246a522023-03-25T05:15:34ZengElsevierJTCVS Open2666-27362023-03-0113200213Extracorporeal membrane oxygenation and microaxial left ventricular assist device in cardiogenic shock: Choosing the right mechanical circulatory support to improve outcomesCentral MessagePerspectiveOlina Dagher, MD0Pierre-Emmanuel Noly, MD, PhD1Walid Ben Ali, MD, PhD2Nadia Bouabdallaoui, MD, PhD3Lucian Geicu, MD4Roxanne Lamanna5Pavan Malhi, BScN6Elizabeth Romero7Anique Ducharme, MD, MSc8Philippe Demers, MD, MSc9Yoan Lamarche, MD, MSc10Department of Surgery, Montreal Heart Institute, Montreal, Quebec, Canada; Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; Department of Cardiac Sciences, Libin Cardiovascular Institute, Calgary, Alberta, CanadaDepartment of Surgery, Montreal Heart Institute, Montreal, Quebec, CanadaDepartment of Surgery, Montreal Heart Institute, Montreal, Quebec, CanadaUniversité de Montréal and Department of Cardiology, Montreal Heart Institute, Montreal, Quebec, CanadaDepartment of Surgery, Montreal Heart Institute, Montreal, Quebec, CanadaFaculty of Medicine, Université de Montréal, Montreal, Quebec, CanadaFaculty of Medicine, Université de Montréal, Montreal, Quebec, CanadaFaculty of Medicine, Université de Montréal, Montreal, Quebec, CanadaFaculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; Université de Montréal and Department of Cardiology, Montreal Heart Institute, Montreal, Quebec, CanadaDepartment of Surgery, Montreal Heart Institute, Montreal, Quebec, CanadaDepartment of Surgery, Montreal Heart Institute, Montreal, Quebec, Canada; Address for reprints: Yoan Lamarche, MD, MSc, 5000 rue Bélanger Est, Montréal, Quebec, H1T 1C8, Canada.Objective: To evaluate the outcomes of patients supported with Impella (CP/5.0) or venoarterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock according to shock phenotype. The primary end point was 30-day survival. Methods: A retrospective study of patients supported with Impella (CP/5.0) or VA-ECMO between 2010 and 2020 was performed. Patients were grouped according to 1 of 2 shock phenotypes: isolated left ventricular (LV) dysfunction versus biventricular dysfunction or multiple organ failure (MOF). The local practice favors Impella for isolated LV dysfunction and VA-ECMO for biventricular dysfunction or MOF. Results: Among the 75 patients included, 17 (23%) had isolated LV dysfunction. Patients with biventricular dysfunction or MOF had a greater median lactate level compared with those with isolated LV dysfunction (7.9 [2.9-11.8] vs 3.8 [1.1-5.8] mmol/L, respectively). Among patients with isolated LV dysfunction, 30-day survival was 46% for the Impella group (n = 13) and 75% for VA-ECMO (n = 4). Among patients with biventricular dysfunction or MOF, 30-day survival was 9% for the Impella group (n = 11) and 28% for VA-ECMO (n = 47). Patients supported with Impella 5.0 had better 30-day survival compared with those supported with Impella CP, for both shock phenotypes (83% vs 14% and 14% vs 0%, respectively). Conclusions: In this small cohort, patients supported with Impella for isolated LV dysfunction and VA-ECMO for biventricular dysfunction or MOF had acceptable survival at 30 days. Patients with biventricular dysfunction or MOF who were supported by Impella had the lowest survival rates. Patients with isolated LV dysfunction who were supported with VA-ECMO had good 30-day survival.http://www.sciencedirect.com/science/article/pii/S2666273623000098cardiogenic shockmechanical circulatory supportImpellaVA-ECMO |
| spellingShingle | Olina Dagher, MD Pierre-Emmanuel Noly, MD, PhD Walid Ben Ali, MD, PhD Nadia Bouabdallaoui, MD, PhD Lucian Geicu, MD Roxanne Lamanna Pavan Malhi, BScN Elizabeth Romero Anique Ducharme, MD, MSc Philippe Demers, MD, MSc Yoan Lamarche, MD, MSc Extracorporeal membrane oxygenation and microaxial left ventricular assist device in cardiogenic shock: Choosing the right mechanical circulatory support to improve outcomesCentral MessagePerspective JTCVS Open cardiogenic shock mechanical circulatory support Impella VA-ECMO |
| title | Extracorporeal membrane oxygenation and microaxial left ventricular assist device in cardiogenic shock: Choosing the right mechanical circulatory support to improve outcomesCentral MessagePerspective |
| title_full | Extracorporeal membrane oxygenation and microaxial left ventricular assist device in cardiogenic shock: Choosing the right mechanical circulatory support to improve outcomesCentral MessagePerspective |
| title_fullStr | Extracorporeal membrane oxygenation and microaxial left ventricular assist device in cardiogenic shock: Choosing the right mechanical circulatory support to improve outcomesCentral MessagePerspective |
| title_full_unstemmed | Extracorporeal membrane oxygenation and microaxial left ventricular assist device in cardiogenic shock: Choosing the right mechanical circulatory support to improve outcomesCentral MessagePerspective |
| title_short | Extracorporeal membrane oxygenation and microaxial left ventricular assist device in cardiogenic shock: Choosing the right mechanical circulatory support to improve outcomesCentral MessagePerspective |
| title_sort | extracorporeal membrane oxygenation and microaxial left ventricular assist device in cardiogenic shock choosing the right mechanical circulatory support to improve outcomescentral messageperspective |
| topic | cardiogenic shock mechanical circulatory support Impella VA-ECMO |
| url | http://www.sciencedirect.com/science/article/pii/S2666273623000098 |
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