Temporal trends of survival and utilization of mechanical circulatory support devices in patients with in‐hospital cardiac arrest secondary to ventricular tachycardia/ventricular fibrillation

Abstract

Background Pulseless ventricular tachycardia/ventricular fibrillation (VT/VF) is the initial rhythm in a third of in‐hospital cardiac arrest patients. Mechanical circulatory support (MCS) device use remains poorly understood in this population. Methods We conducted an observational analysis of temporal trends in the utilization of MCS in VT/VF IHCA between January 2008 and December 2014 utilizing the Nationwide Inpatient Sample (NIS) database. Using multivariable analysis, we assessed factors associated with MCS use and survival to discharge. Results Among 151,628 hospitalizations with VT/VF IHCA, 14,981 (9.9%) received MCS. Intra‐aortic balloon pump (IABP) was the most commonly used MCS (9.1%). From 2008 to 2014, there was significant increase in the utilization of MCS (8.7–11%; ptrend < 0.0001). On multivariable analysis, there was 12‐fold increase and three‐fold increase in the utilization of PVAD and ECMO respectively; however, there was no significant change in the use of IABP. Over the seven‐year sample period, there was significant increase in the overall survival to hospital discharge (35.4–43.5%; ptrend < 0.0001). Survival to hospital discharge increased in both MCS and non‐MCS groups. Conclusion There was significant increase in utilization of MCS after VT/VF IHCA during the study period. IABP was the most commonly utilized MCS. The survival to hospital discharge increased in the overall study population including both MCS and non‐MCS groups. Future studies are needed to identify patient population most likely to benefit from the use of MCS after VT/VF IHCA.

Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature*

“…Of 17 studies examining insurance status, one from South Korea showed higher ECMO use in patients with NHI versus “medical aid” (164). Of 16 U.S. studies, four found no difference (31, 139, 159, 165), 10 showed greater use in patients with private insurance (vs government insurance) (28, 89, 129, 132, 137, 148, 154, 160, 166) or any insurance (vs uninsured) (167). One obstetric study observed higher ECMO use with government insurance (155), and another showed lower ECMO use in insured patients with COVID-19 (138).…”

The prognostic value of initial serum lactate for survival in postcardiac arrest patients undergoing cardiac catheterization

“…We also demonstrate a trend toward greater usage of MCS devices in patients who did not survive. Previous studies have demonstrated improved outcomes in IHCA 24,25 and OHCA 26 when MCS is used. Caution should be exercised with associating higher mortality and MCS use in this small study.…”

Subphenotypes of Cardiac Arrest Patients Admitted to Intensive Care Unit: a latent profile analysis of a large critical care database

“…Finally, the current study did not allow to distinguish between intra-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA). It has been observed that OHCA and IHCA can be quite different in clinical presentations and outcomes 31,32 .…”