Complications of Temporary Percutaneous Mechanical Circulatory Support for Cardiogenic Shock: An Appraisal of Contemporary Literature

Subramaniam, Anna V.; Barsness, Gregory W.; Vallabhajosyula, Saarwaani; Vallabhajosyula, Saraschandra

doi:10.1007/s40119-019-00152-8

Cited by 109 publications

(122 citation statements)

References 145 publications

(318 reference statements)

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“…In patients with AMI, ECMO is often used to support tenuous hemodynamics during cardiac arrest, cardiopulmonary resuscitation, cardiogenic shock, and high risk coronary intervention [1][2][3][4][5][6][7][8]. However, by virtue of its unique configuration, ECMO is associated with higher left ventricular afterload, greater vascular complications due to large bore access, limb ischemia due to lack of antegrade flow, greater clotting, and thrombocytopenia due to a complex circuit and higher risk of strokes due to variation in anticoagulation [1]. There are limited data on the complications in AMI patients supported with ECMO [1].…”

Section: Discussionmentioning

confidence: 99%

“…However, by virtue of its unique configuration, ECMO is associated with higher left ventricular afterload, greater vascular complications due to large bore access, limb ischemia due to lack of antegrade flow, greater clotting, and thrombocytopenia due to a complex circuit and higher risk of strokes due to variation in anticoagulation [1]. There are limited data on the complications in AMI patients supported with ECMO [1]. In this study, we report comparable rates of hemorrhage, blood transfusion, arterial injury and limb ischemia, but slightly higher rates of thrombocytopenia compared to prevalent literature [1].…”

Section: Discussionmentioning

confidence: 99%

“…Extracorporeal membrane oxygenation (ECMO) is increasingly used in acute cardiovascular care for the management of acute myocardial infarction (AMI) complicated by cardiac arrest, cardiogenic shock and complications from cardiac interventional procedures [1][2][3][4][5][6][7][8][9][10]. ECMO provides cardiac output support of nearly 3-5 L, biventricular support and respiratory support, thereby assisting with critical cardiorespiratory support in extreme situations [11].…”

Section: Introductionmentioning

confidence: 99%

“…Despite the stated benefits from ECMO therapy, these acutely ill patients receiving ECMO support for AMI continue to experience high in-hospital mortality [7]. As compared to the intra-aortic balloon pump (IABP), the newer mechanical circulatory devices, such as the percutaneous left ventricular assist device (pLVAD) and ECMO, are associated with higher rates of complications [1]. There are limited contemporary data on complications in AMI patients receiving ECMO support [1].…”

Section: Introductionmentioning

confidence: 99%

“…As compared to the intra-aortic balloon pump (IABP), the newer mechanical circulatory devices, such as the percutaneous left ventricular assist device (pLVAD) and ECMO, are associated with higher rates of complications [1]. There are limited contemporary data on complications in AMI patients receiving ECMO support [1]. As compared to other populations receiving ECMO support such as acute decompensated heart failure and post-cardiotomy cardiogenic shock, AMI patients are unique in the urgency related to insertion, often receive peripheral cannulation, may benefit from left ventricular unloading, may have concomitant cardiac arrest, and constitute >80% of cardiogenic shock etiology.…”

Section: Introductionmentioning

confidence: 99%

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Complications in Patients with Acute Myocardial Infarction Supported with Extracorporeal Membrane Oxygenation

Vallabhajosyula

Bell

Sandhu

et al. 2020

JCM

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Background: There are limited data on complications in acute myocardial infarction (AMI) admissions receiving extracorporeal membrane oxygenation (ECMO). Methods: Adult (>18 years) admissions with AMI receiving ECMO support were identified from the National Inpatient Sample database between 2000 and 2016. Complications were classified as vascular, lower limb amputation, hematologic, and neurologic. Outcomes of interest included temporal trends, in-hospital mortality, hospitalization costs, and length of stay. Results: In this 17-year period, in~10 million AMI admissions, ECMO support was used in 4608 admissions (<0.01%)-mean age 59.5 ± 11.0 years, 75.7% men, 58.9% white race. Median time to ECMO placement was 1 (interquartile range [IQR] 0-3) day. Complications were noted in 2571 (55.8%) admissions-vascular 6.1%, lower limb amputations 1.1%, hematologic 49.3%, and neurologic 9.9%. There was a steady increase in overall complications during the study period (21.1% in 2000 vs. 70.5% in 2016). The cohort with complications, compared to those without complications, had comparable adjusted in-hospital mortality (60.7% vs. 54.0%; adjusted odds ratio 0.89 [95% confidence interval 0.77-1.02]; p = 0.10) but longer median hospital stay (12 [IQR 5-24] vs. 7 [IQR 3-21] days), higher median hospitalization costs ($458,954 [IQR 260,871] vs. 302,255 [IQR 173,660]), fewer discharges to home (14.7% vs. 17.9%), and higher discharges to skilled nursing facilities (44.1% vs. 33.9%) (all p < 0.001). Conclusions: Over half of all AMI admissions receiving ECMO support develop one or more severe complications. Complications were associated with higher resource utilization during and after the index hospitalization.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Complications in Patients with Acute Myocardial Infarction Supported with Extracorporeal Membrane Oxygenation

Vallabhajosyula

Bell

Sandhu

et al. 2020

JCM

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Predicting mortality in cardiogenic shock secondary to ACS requiring short‐term mechanical circulatory support: The ACS‐MCS score

Marashly

Taleb

Kyriakopoulos

et al. 2021

Cathet Cardio Intervent

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Objective To identify predictors of 30‐day all‐cause mortality for patients with cardiogenic shock secondary to acute coronary syndrome (ACS‐CS) who require short‐term mechanical circulatory support (ST‐MCS). Background ACS‐CS mortality is high. ST‐MCS is an attractive treatment option for hemodynamic support and stabilization of deteriorating patients. Mortality prediction modeling for ACS‐CS patients requiring ST‐MCS has not been well‐defined. Methods The Utah Cardiac Recovery (UCAR) Shock database was used to identify patients admitted with ACS‐CS requiring ST‐MCS devices between May 2008 and August 2018. Pre‐ST‐MCS clinical, laboratory, echocardiographic, and angiographic data were collected. The primary endpoint was 30‐day all‐cause mortality. A weighted score comprising of pre‐ST‐MCS variables independently associated with 30‐day all‐cause mortality was derived and internally validated. Results A total of 159 patients (mean age, 61 years; 78% male) were included. Thirty‐day all‐cause mortality was 49%. Multivariable analysis resulted in four independent predictors of 30‐day all‐cause mortality: age, lactate, SCAI CS classification, and acute kidney injury. The model had good calibration and discrimination (area under the receiver operating characteristics curve 0.80). A predictive score (ranging 0–4) comprised of age ≥ 60 years, pre‐ST‐MCS lactate ≥2.5 mmol/L, AKI at time of ST‐MCS implementation, and SCAI CS stage E effectively risk stratified our patient population. Conclusion The ACS‐MCS score is a simple and practical predictive score to risk‐stratify CS secondary to ACS patients based on their mortality risk. Effective mortality risk assessment for ACS‐CS patients could have implications on patient selection for available therapeutic strategy options.

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Rates and impact of vascular complications in mechanical circulatory support

Lemor

Dabbagh

Cohen

et al. 2022

Cathet Cardio Intervent

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Background Mechanical circulatory support (MCS) devices are increasingly used for hemodynamic support in cardiogenic shock or high‐risk percutaneous coronary interventions. Vascular complications remain a major source of morbidity and mortality despite technological advances with percutaneous techniques. Little is known about the rates and predictors of vascular complications with large‐bore access MCS in the contemporary era. Methods The study cohort was derived from National Inpatient Sample using data from 2015 to 2019 for cardiac hospitalizations with the use of: intra‐aortic balloon pump (IABP) Impella, and/or extracorporeal membrane oxygenation (ECMO). The rates of vascular complications and in‐hospital outcomes were analyzed using multivariable logistic regression. Results Of 221,700 hospitalizations with MCS use, the majority had only IABP (68%). The rates of vascular complications were greatest with ECMO (15.8%) when compared with IABP (3.0%) and Impella (5.6%). Among patients with vascular complications, in‐hospital mortality was higher with ECMO (56.3%) when compared with IABP (26.2%) and Impella (33.8%). Peripheral arterial disease (PAD) was the strongest predictor of vascular complications, with 10 times higher odds when present (adjusted odds ratio [aOR] 10.96, p < 0.001). In risk‐adjusted models, when compared with IABP, the use of Impella (aOR: 1.73, p < 0.001), ECMO (aOR: 5.35, p < 0.001), or a combination of MCS devices (aOR: 3.47, p < 0.001) was associated with higher odds of vascular complications. Conclusions In contemporary practice, the use of MCS is associated with significant vascular complications and in‐hospital mortality. Predictors of vascular complications include larger arteriotomy size, female gender, and peripheral arterial disease. Vascular access management remains essential to prevent major complications.

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Complications of Temporary Percutaneous Mechanical Circulatory Support for Cardiogenic Shock: An Appraisal of Contemporary Literature

Cited by 109 publications

References 145 publications

Complications in Patients with Acute Myocardial Infarction Supported with Extracorporeal Membrane Oxygenation

Complications in Patients with Acute Myocardial Infarction Supported with Extracorporeal Membrane Oxygenation

Predicting mortality in cardiogenic shock secondary to ACS requiring short‐term mechanical circulatory support: The ACS‐MCS score

Rates and impact of vascular complications in mechanical circulatory support

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