PMID- 23260710
OWN - NLM
STAT- MEDLINE
DCOM- 20130603
LR  - 20220408
IS  - 1557-3117 (Electronic)
IS  - 1053-2498 (Linking)
VI  - 32
IP  - 1
DP  - 2013 Jan
TI  - Clinical outcome of mechanical circulatory support for refractory cardiogenic 
      shock in the current era.
PG  - 106-11
LID - S1053-2498(12)01362-9 [pii]
LID - 10.1016/j.healun.2012.10.005 [doi]
AB  - BACKGROUND: Mortality for refractory cardiogenic shock (RCS) remains high. 
      However, with improving mechanical circulatory support device (MCSD) technology, 
      the treatment options for RCS patients are expanding. We report on a recent 
      5-year single-center experience with MCSD for treatment of RCS. METHODS: This 
      study was a retrospective review of adult patients who required an MCSD due to 
      RCS in the past 5 years. We excluded those patients with post-cardiotomy shock 
      and post-transplant cardiac graft dysfunction. In the setting of RCS, a 
      short-term ventricular assist device (VAD) was inserted as a bridge-to-decision 
      device. Veno-arterial extracorporeal membrane oxygenation (VA ECMO) was chosen in 
      cases of unknown neurologic status, complete hemodynamic collapse or severe 
      coagulopathy. RESULTS: From January 2007 through January 2012, 90 patients 
      received an MCSD for RCS, 21 (23%) of whom had active cardiopulmonary 
      resuscitation (CPR). The etiology of RCS included acute myocardial infarction in 
      49% and acute decompensated heart failure in 27%. Mean age was 53+/-14 years, 71% 
      were male, and 60% had an intra-aortic balloon pump. The initial approach 
      utilized was short-term VAD in 49% and VA ECMO in 51%. Median length of support 
      was 8 days (IQR 4 to 18 days). Exchange to implantable VAD was performed in 26% 
      of patients. Other destinations included myocardial recovery in 18% and heart 
      transplantation in 11%. Survival to hospital discharge was 49%. Multivariate 
      analysis showed ongoing CPR to be an independent risk factor for mortality (OR = 
      5.79, 95% CI 1.285 to 26.08, p = 0.022). CONCLUSIONS: In the current era, roughly 
      half of the patients who need an MCSD for RCS survive, and roughly half of these 
      survivors require an implantable VAD. Ongoing CPR is predictive of in-hospital 
      mortality.
CI  - Copyright (c) 2013 International Society for Heart and Lung Transplantation. 
      Published by Elsevier Inc. All rights reserved.
FAU - Takayama, Hiroo
AU  - Takayama H
AD  - Department of Surgery, Columbia University Medical Center, New York, New York 
      10032, USA. hirofu2@hotmail.com
FAU - Truby, Lauren
AU  - Truby L
FAU - Koekort, Michael
AU  - Koekort M
FAU - Uriel, Nir
AU  - Uriel N
FAU - Colombo, Paolo
AU  - Colombo P
FAU - Mancini, Donna M
AU  - Mancini DM
FAU - Jorde, Ulrich P
AU  - Jorde UP
FAU - Naka, Yoshifumi
AU  - Naka Y
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Heart Lung Transplant
JT  - The Journal of heart and lung transplantation : the official publication of the 
      International Society for Heart Transplantation
JID - 9102703
SB  - IM
MH  - Algorithms
MH  - Female
MH  - *Heart-Assist Devices
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Shock, Cardiogenic/mortality/*surgery
MH  - Treatment Outcome
EDAT- 2012/12/25 06:00
MHDA- 2013/06/05 06:00
CRDT- 2012/12/25 06:00
PHST- 2012/07/06 00:00 [received]
PHST- 2012/09/25 00:00 [revised]
PHST- 2012/10/17 00:00 [accepted]
PHST- 2012/12/25 06:00 [entrez]
PHST- 2012/12/25 06:00 [pubmed]
PHST- 2013/06/05 06:00 [medline]
AID - S1053-2498(12)01362-9 [pii]
AID - 10.1016/j.healun.2012.10.005 [doi]
PST - ppublish
SO  - J Heart Lung Transplant. 2013 Jan;32(1):106-11. doi: 
      10.1016/j.healun.2012.10.005.