Trends in utilization of mechanical circulatory support in patients hospitalized after out-of-hospital cardiac arrest

Patel, Nileshkumar; Patel, Nish; Bhardwaj, Bhaskar; Golwala, Harsh; Kumar, Varun; Atti, Varunsiri; Arora, Shilpkumar; Patel, Sanjay; Patel, Nilay; Hernandez, Gabriel A.; Badheka, Apurva; Alfonso, Carlos; Cohen, Mauricio G.; Bhatt, Deepak L.; Kapur, Navin K.

doi:10.1016/j.resuscitation.2018.04.007

Cited by 34 publications

(24 citation statements)

References 39 publications

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“…Recent results from a US database suggest an increase in the use of VA-ECMO for ECPR from 2008 to 2014 (0.1% to 0.7%, p trend <0.001) with 3650 (0.4%) patients hospitalized after out-of-hospital cardiac arrest implanted with VA-ECMO on the overall period. Survival to discharge was significantly higher in patients who were selected to receive TCS (56.9% vs. 43.1%, OR 1.16 95%CI (1.11-1.21), p<0.001) (28). In a propensity-matched retrospective study comparing the outcomes and the long-term neurologic prognosis of cardiac arrest treated with ECPR (n=80) or conventional cardiopulmonary resuscitation (n=80), survival to hospital discharge was not different between groups (ECPR 23% vs. 18%, p=0.4) while the cox-regression analysis stratified by matched pairs showed higher favorable neurological (Cerebral Performance Category 1-2) outcome rate in the ECPR group (log-rank test p=0.003) (29).…”

Section: Cardiac Arrestmentioning

confidence: 93%

Venoarterial extracorporeal membrane oxygenation in cardiogenic shock: indications, mode of operation, and current evidence

Chambrun

Bréchot

Combes

2019

Current Opinion in Critical Care

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Purpose of review: Temporary circulatory support (TCS) with venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used as a salvage therapy for patients with refractory cardiogenic shock. This article provides an overview of VA-ECMO principles, indications, management, complications and discusses the results of recent case series and trials. Recent findings: VA-ECMO is utilized as a bridge to "decision" that includes weaning after cardiac function recovery, transplantation, long-term mechanical circulatory support and withdrawal in case of futility. VA-ECMO is considered the first-line TCS since it allows rapid improvement in oxygenation, is less expensive, and is also suitable for patients with biventricular failure. Combining Impella or intra-aortic balloon pump support with VA-ECMO might decrease left ventricular pressure and improve outcomes. Massive pulmonary embolism, sepsis-associated cardiomyopathy, refractory cardiac arrest are among emerging indications for TCS. Summary: TCS have become the cornerstone of the management of patients with cardiogenic shock, although the evidence supporting their efficacy is limited. VA-ECMO is considered the first-line option, with a growing number of accepted and emerging indications. Randomized clinical trials are now needed to determine the place VA-ECMO in cardiogenic shock treatment strategies.

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Section: Cardiac Arrestmentioning

confidence: 93%

Venoarterial extracorporeal membrane oxygenation in cardiogenic shock: indications, mode of operation, and current evidence

Chambrun

Bréchot

Combes

2019

Current Opinion in Critical Care

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“…Although major advances in resuscitation techniques have improved survival over the past decade, studies have shown that as high as one half of the patients with IHCA do not achieve ROSC and about three fourths of patients do not survive to hospital discharge . Previously, we studied the temporal trends of MCS use in OHCA and found an increasing utilization of MCS along with a corresponding increase in survival to discharge among these patients . However, data on the utilization of MCS in IHCA are scarce.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, we analyzed the differences in survival to discharge by the presence or absence of STEMI (ST-elevation myocardial infarction). 21 Data were complete for all covariates except race (8.81%) and primary expected payer (0.2%). We accounted for missing values using the fully conditional specification method (an iterative Markov Chain Monte Carlo algorithm) in STATA statistical software, version 11.0 (Stata Corp).…”

Section: Discussionmentioning

confidence: 99%

“…A simple linear regression model was used to generate parameter estimates and confidence intervals for cost of hospitalization using 2008 as a reference year. Furthermore, we analyzed the differences in survival to discharge by the presence or absence of STEMI (ST‐elevation myocardial infarction) …”

Section: Methodsmentioning

confidence: 99%

“…Sensitivity analysis confirmed these findings, Supporting Information Previously, we studied the temporal trends of MCS use in OHCA and found an increasing utilization of MCS along with a corresponding increase in survival to discharge among these patients. 21 However, data on the utilization of MCS in IHCA are scarce. IHCA patients differ significantly from OHCA patients as they usually carry a higher burden of comorbidities.…”

Section: Baseline Characteristicsmentioning

confidence: 99%

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

Patel

Atti

Kumar

et al. 2019

Cathet Cardio Intervent

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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.

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

Rosenberg

Guo

Chatterjee

et al. 2020

Cathet Cardio Intervent

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Objectives We sought to investigate the prognostic value of serum lactate on survival in patients postcardiac arrest. Background Patients who experience cardiac arrest, in‐ or out‐of‐hospital, may have a poor outcome. Initial electrocardiograms may suggest ischemia as an underlying cause and urgent referral for catheterization occurs. It remains unclear which of these patients may suffer a poor outcome. Methods We retrospectively reviewed all patients at our institution taken for urgent catheterization after cardiac arrest between January 2014 and September 2018. Three hundred and eighty four patients were referred urgently to the cath lab during this period, 50 with prior arrest. Results Sixty six percent underwent coronary intervention. The mean age of the entire cohort was 57 years. Thirty four percent were female, 40% had a history of coronary artery disease, and 94% were intubated at the time of cardiac catheterization. Overall survival to discharge was 40%. Survival in patients who underwent coronary intervention compared with those who did not was similar (45.5 vs. 29.4%, p = .27). Mean lactate level in survivors versus nonsurvivors was 4.7 ± 3.8 and 9.8 ± 4.7 mmol/L, respectively (p < .05). When divided into tertiles by serum lactate (< 4.5, 4.5–9, 9 mmol/L), survival to discharge was 75, 29.4, and 17.6%, respectively (p < .05). Initial serum lactate and age were independent predictors of in‐hospital mortality. Conclusions In patients undergoing cardiac catheterization following cardiac arrest, routine measurement of serum lactate is a useful and available laboratory test that may help identify patients at risk for a poor outcome.

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Trends in utilization of mechanical circulatory support in patients hospitalized after out-of-hospital cardiac arrest

Cited by 34 publications

References 39 publications

Venoarterial extracorporeal membrane oxygenation in cardiogenic shock: indications, mode of operation, and current evidence

Venoarterial extracorporeal membrane oxygenation in cardiogenic shock: indications, mode of operation, and current evidence

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

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

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