Predictive factors for successful weaning from percutaneous cardiopulmonary support in patients with cardiogenic shock complicating acute myocardial infarction

Morisawa, Daisuke; Higuchi, Yoshiharu; Iwakura, Katsuomi; Okamura, Atsunori; Date, Motoo; Ohmiya, Shigemiki; Shibuya, Masabumi; Fujii, Kenshi

doi:10.1016/j.jjcc.2012.06.005

Cited by 8 publications

(8 citation statements)

References 26 publications

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“…Some available studies compared serum creatinine at the time of ECMO initiation in survivors with that of non-survivors, but no significant differences were found [30,31]. This was the same result in our study.…”

Section: Discussionsupporting

confidence: 84%

Prognostic effect of estimated glomerular filtration rate in patients with cardiogenic shock or cardiac arrest undergoing percutaneous veno-arterial extracorporeal membrane oxygenation

Kuroki

Asaoka

Iwama

et al. 2016

Journal of Cardiology

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Section: Discussionsupporting

confidence: 84%

Prognostic effect of estimated glomerular filtration rate in patients with cardiogenic shock or cardiac arrest undergoing percutaneous veno-arterial extracorporeal membrane oxygenation

Kuroki

Asaoka

Iwama

et al. 2016

Journal of Cardiology

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“…The mortality of our study is comparable, but slightly higher than that of the most recent studies on AMI, which reported in-hospital mortality rates ranging from 34% to 67% 13,14,15,16. The most likely explanation is patient selection.…”

Section: Discussionsupporting

confidence: 48%

“…Therefore, we could not conclude the benefit of PCPS over medical therapy or other mechanical assist devices. As a randomized trial of strategy would be quite difficult to perform and the sample size of our study was larger than that of previous studies,13,14,15 our data could provide more assistive information about clinical outcomes of AMI shock treatment.…”

Section: Discussionmentioning

confidence: 90%

Clinical Outcomes of Patients with Acute Myocardial Infarction Complicated by Severe Refractory Cardiogenic Shock Assisted with Percutaneous Cardiopulmonary Support

et al. 2014

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PurposeLimited data are available on the role of percutaneous cardiopulmonary support (PCPS) for the treatment of acute myocardial infarction (AMI) patients with cardiogenic shock. We investigated the clinical outcomes and predictors of in-hospital mortality after PCPS in patients with AMI complicated by severe refractory cardiogenic shock.Materials and MethodsFrom January 2004 to December 2011, we analyzed data from 96 consecutive AMI patients with cardiogenic shock assisted by a PCPS system. The primary outcome was in-hospital mortality. The predictors of in-hospital mortality were determined by a Cox proportional-hazards model.ResultsIn-hospital mortality occurred in 51 (53.1%) patients and 58 (60.4%) patients were able to be weaned from PCPS. Cardiopulmonary resuscitation (CPR) was performed in 61 (63.5%) patients before PCPS initiation. On multivariate analysis, age ≥67 years [adjusted hazard ratio (HR), 4.74; 95% confidence interval (CI), 2.27-9.93; p<0.001], CPR (adjusted HR, 2.32; 95% CI, 1.11-4.85; p=0.03), lactate clearance for 48 hours <70% (adjusted HR, 2.50; 95% CI, 1.04-6.05; p=0.041), and unsuccessful revascularization (adjusted HR, 3.57; 95% CI, 1.85-6.90; p=0.002) were independent predictors of in-hospital mortality after PCPS in patients with AMI complicated by cardiogenic shock.ConclusionIn spite of PCPS management, AMI patients complicated by severe refractory cardiogenic shock demonstrated high mortality. Older age, CPR, lower lactate clearance for 48 hours, and unsuccessful revascularization were independent predictors of in-hospital mortality.

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“…Efforts were made to compensate for these differences in the multivariable analysis, but we may not have been able to overcome the differences. Fourth, our data included a large number of patients who underwent CPR and thus showed a higher mortality than in another recent randomized trial and a registry of cardiogenic shock [3,19]. Even if there are minor benefits of IABP support, additional effects might not be evident in patients with very severe cardiogenic shock.…”

Section: Discussionmentioning

confidence: 94%

Clinical impact of intra-aortic balloon pump during extracorporeal life support in patients with acute myocardial infarction complicated by cardiogenic shock

et al. 2014

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BackgroundThere is no available data on clinical outcome in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock who are supported by an intra-aortic balloon pump (IABP) in combination with extracorporeal life support (ECLS).MethodsWe analysed 96 consecutive patients with AMI and complicating cardiogenic shock who were assisted by an ECLS system between January 2004 and December 2011. The primary outcome was in-hospital mortality. The secondary outcomes were the success rate of weaning from ECLS and the lactate clearance for 48 hours (%).ResultsA combination of IABP and ECLS was used in 41 (42.7%) patients. In-hospital mortality occurred for 51 patients (ECLS with IABP versus ECLS alone; 51.2% vs. 54.5%, p = 0.747). The success rate of weaning from ECLS was similar between the two groups (63.4% vs. 58.2%, p = 0.604). Complications such as ischemia of a lower extremity or bleeding at the ECLS insertion site (p = 0.521 and p = 0.667, respectively) did not increase when ECLS was combined with IABP. Among patients who survived for 24 hours after intervention, lactate clearance was not significantly different between patients who received ECLS alone and those who received ECLS with IABP (p = 0.918).ConclusionsThe combined use of ECLS and IABP did not improve in-hospital survival in patients with AMI complicated by cardiogenic shock.

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Predictive factors for successful weaning from percutaneous cardiopulmonary support in patients with cardiogenic shock complicating acute myocardial infarction

Abstract: A reduction in PCPS flow without hemodynamic collapse may allow for successful weaning from PCPS. BE may be a potent factor in determining when to terminate PCPS.

Cited by 8 publications

References 26 publications

Prognostic effect of estimated glomerular filtration rate in patients with cardiogenic shock or cardiac arrest undergoing percutaneous veno-arterial extracorporeal membrane oxygenation

Prognostic effect of estimated glomerular filtration rate in patients with cardiogenic shock or cardiac arrest undergoing percutaneous veno-arterial extracorporeal membrane oxygenation

Clinical Outcomes of Patients with Acute Myocardial Infarction Complicated by Severe Refractory Cardiogenic Shock Assisted with Percutaneous Cardiopulmonary Support

Clinical impact of intra-aortic balloon pump during extracorporeal life support in patients with acute myocardial infarction complicated by cardiogenic shock

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