Clinical Practice Patterns in Temporary Mechanical Circulatory Support for Shock in the Critical Care Cardiology Trials Network (CCCTN) Registry

Abstract

Background: Temporary mechanical circulatory support (MCS) devices provide hemodynamic assistance for shock refractory to pharmacological treatment. Most registries have focused on single devices or specific etiologies of shock, limiting data regarding overall practice patterns with temporary MCS in cardiac intensive care units. Methods: The CCCTN (Critical Care Cardiology Trials Network) is a multicenter network of tertiary CICUs in North America. Between September 2017 and September 2018, each center (n=16) contributed a 2-month snapshot of consecutive medical CICU admissions. Results: Of the 270 admissions using temporary MCS, 33% had acute myocardial infarction-related cardiogenic shock (CS), 31% had CS not related to acute myocardial infarction, 11% had mixed shock, and 22% had an indication other than shock. Among all 585 admissions with CS or mixed shock, 34% used temporary MCS during the CICU stay with substantial variation between centers (range: 17%–50%). The most common temporary MCS devices were intraaortic balloon pumps (72%), Impella (17%), and veno-arterial extracorporeal membrane oxygenation (11%), although intraaortic balloon pump use also varied between centers (range: 40%–100%). Patients managed with intraaortic balloon pump versus other forms of MCS (advanced MCS) had lower Sequential Organ Failure Assessment scores and less severe metabolic derangements. Illness severity was similar at high- versus low-MCS utilizing centers and at centers with more advanced MCS use. Conclusions: There is wide variation in the use of temporary MCS among patients with shock in tertiary CICUs. While hospital-level variation in temporary MCS device selection is not explained by differences in illness severity, patient-level variation appears to be related, at least in part, to illness severity.

Prognostic Impact of Active Mechanical Circulatory Support in Cardiogenic Shock Complicating Acute Myocardial Infarction, Results from the Culprit-Shock Trial

“…With the exception of the IMPRESS-in-Severe-SHOCK trial, which included younger patients, the age of included patients in previous RCTs of active MCS was similar to the present study [14,[22][23][24]. On the other hand, previous cohort studies showed a lower age of patients receiving active MCS, which might be due to selection bias [17,27,31,32]. The shock index, which was identified as a strong outcome predictor in STEMI patients, was higher in patients receiving active MCS [33].…”

“…These devices, among others, include the microaxial flow pumps from the Impella ® family, the TandemHeart ® and ECMO [6]. Although frequently used in clinical routine, data supporting a prognostic benefit with active MCS devices in infarct-related CS are limited [14][15][16][22][23][24][25][26][27][28][29][30]. The aim of the present analysis was to investigate the prognostic role of active MCS devices rather than an outcome analysis of patients treated with IABP.…”

“…The frequency of Impella ® use increased over time, reaching 31.9% in 2016. Another US registry reported rates of 72%, 17% and 11% for IABP, Impella ® and ECMO support between 2017 and 2018 [27]. According to a recent report from a large registry study from Switzerland, Impella ® or ECMO are used in approximately 10% of patients with infarct-related CS, with increasing rates during the last seven years [35].…”

Strengthening the Concept of Preventive Theory (Sadd aż-Żarī'ah) Against Adolescent Reproductive Health

“…When asked about information about changes in adolescent reproductive health, there were significant differences, found that 60.56% were; "Sometimes, but uncomfortable" "Sometimes I talk about other things" "Always, even if I avoid" "Always, when I'm happy" "Never (because of shame and confusion)" "Never (because of my secret)" "There's no use for me to tell (you don't understand)" "About weight gain" "Maybe for the current era promiscuity has become something that is often done, but as teenagers, we must have a firm principle to reject it" [10]Kessler RC, Angermeyer M, Anthony JC, Berg [11] states that adolescence is an important period in developing and maintaining social and emotional habits that are important for mental health. These conditions include adopting a healthy sleep pattern; do regular exercise; develop coping, problem-solving, and interpersonal skills, including learning to manage emotions.…”

Prevention of Complications in the Cardiac Intensive Care Unit

“…Approximately 34% of patients in a multicenter network of tertiary cardiac intensive care units in North America were managed with a mechanical device in the intensive care unit. 23 The critical care team managing these patients will need to understand the various forms of mechanical support. As new devices are introduced, topics, such as anticoagulation, device placement, and appropriate pressure/flow monitoring, will need to be discussed during multidisciplinary daily rounds.…”