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Comparison of Mechanical Support with Impella or Extracorporeal Life Support in Post-Cardiac Arrest Cardiogenic Shock: A Propensity Scoring Matching Analysis

Our aim was to compare the outcomes of Impella with extracorporeal life support (ECLS) in patients with post-cardiac arrest cardiogenic shock (CS) complicating acute myocardial infarction (AMI). This was a retrospective study of patients resuscitated from out of hospital cardiac arrest (OHCA) with p...

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Autores principales: Syntila, Styliani, Chatzis, Georgios, Markus, Birgit, Ahrens, Holger, Waechter, Christian, Luesebrink, Ulrich, Divchev, Dimitar, Schuett, Harald, Tsalouchidou, Panagiota-Eleni, Jerrentrup, Andreas, Parahuleva, Mariana, Schieffer, Bernhard, Karatolios, Konstantinos
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8396971/
https://www.ncbi.nlm.nih.gov/pubmed/34441879
http://dx.doi.org/10.3390/jcm10163583
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author Syntila, Styliani
Chatzis, Georgios
Markus, Birgit
Ahrens, Holger
Waechter, Christian
Luesebrink, Ulrich
Divchev, Dimitar
Schuett, Harald
Tsalouchidou, Panagiota-Eleni
Jerrentrup, Andreas
Parahuleva, Mariana
Schieffer, Bernhard
Karatolios, Konstantinos
author_facet Syntila, Styliani
Chatzis, Georgios
Markus, Birgit
Ahrens, Holger
Waechter, Christian
Luesebrink, Ulrich
Divchev, Dimitar
Schuett, Harald
Tsalouchidou, Panagiota-Eleni
Jerrentrup, Andreas
Parahuleva, Mariana
Schieffer, Bernhard
Karatolios, Konstantinos
author_sort Syntila, Styliani
collection PubMed
description Our aim was to compare the outcomes of Impella with extracorporeal life support (ECLS) in patients with post-cardiac arrest cardiogenic shock (CS) complicating acute myocardial infarction (AMI). This was a retrospective study of patients resuscitated from out of hospital cardiac arrest (OHCA) with post-cardiac arrest CS following AMI (May 2015 to May 2020). Patients were supported either with Impella 2.5/CP or ECLS. Outcomes were compared using propensity score-matched analysis to account for differences in baseline characteristics between groups. 159 patients were included (Impella, n = 105; ECLS, n = 54). Hospital and 12-month survival rates were comparable in the Impella and the ECLS groups (p = 0.16 and p = 0.3, respectively). After adjustment for baseline differences, both groups demonstrated comparable hospital and 12-month survival (p = 0.36 and p = 0.64, respectively). Impella patients had a significantly greater left ventricle ejection-fraction (LVEF) improvement at 96 h (p < 0.01 vs. p = 0.44 in ECLS) and significantly fewer device-associated complications than ECLS patients (15.2% versus 35.2%, p < 0.01 for relevant access site bleeding, 7.6% versus 20.4%, p = 0.04 for limb ischemia needing intervention). In subgroup analyses, Impella was associated with better survival in patients with lower-risk features (lactate < 8.6 mmol/L, time from collapse to return of spontaneous circulation < 28 min, vasoactive score < 46 and Horowitz index > 182). In conclusion, the use of Impella 2.5/CP or ECLS in post-cardiac arrest CS after AMI was associated with comparable adjusted hospital and 12-month survival. Impella patients had a greater LVEF improvement than ECLS patients. Device-related access-site complications occurred more frequently in patients with ECLS than Impella support.
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spelling pubmed-83969712021-08-28 Comparison of Mechanical Support with Impella or Extracorporeal Life Support in Post-Cardiac Arrest Cardiogenic Shock: A Propensity Scoring Matching Analysis Syntila, Styliani Chatzis, Georgios Markus, Birgit Ahrens, Holger Waechter, Christian Luesebrink, Ulrich Divchev, Dimitar Schuett, Harald Tsalouchidou, Panagiota-Eleni Jerrentrup, Andreas Parahuleva, Mariana Schieffer, Bernhard Karatolios, Konstantinos J Clin Med Article Our aim was to compare the outcomes of Impella with extracorporeal life support (ECLS) in patients with post-cardiac arrest cardiogenic shock (CS) complicating acute myocardial infarction (AMI). This was a retrospective study of patients resuscitated from out of hospital cardiac arrest (OHCA) with post-cardiac arrest CS following AMI (May 2015 to May 2020). Patients were supported either with Impella 2.5/CP or ECLS. Outcomes were compared using propensity score-matched analysis to account for differences in baseline characteristics between groups. 159 patients were included (Impella, n = 105; ECLS, n = 54). Hospital and 12-month survival rates were comparable in the Impella and the ECLS groups (p = 0.16 and p = 0.3, respectively). After adjustment for baseline differences, both groups demonstrated comparable hospital and 12-month survival (p = 0.36 and p = 0.64, respectively). Impella patients had a significantly greater left ventricle ejection-fraction (LVEF) improvement at 96 h (p < 0.01 vs. p = 0.44 in ECLS) and significantly fewer device-associated complications than ECLS patients (15.2% versus 35.2%, p < 0.01 for relevant access site bleeding, 7.6% versus 20.4%, p = 0.04 for limb ischemia needing intervention). In subgroup analyses, Impella was associated with better survival in patients with lower-risk features (lactate < 8.6 mmol/L, time from collapse to return of spontaneous circulation < 28 min, vasoactive score < 46 and Horowitz index > 182). In conclusion, the use of Impella 2.5/CP or ECLS in post-cardiac arrest CS after AMI was associated with comparable adjusted hospital and 12-month survival. Impella patients had a greater LVEF improvement than ECLS patients. Device-related access-site complications occurred more frequently in patients with ECLS than Impella support. MDPI 2021-08-14 /pmc/articles/PMC8396971/ /pubmed/34441879 http://dx.doi.org/10.3390/jcm10163583 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Syntila, Styliani
Chatzis, Georgios
Markus, Birgit
Ahrens, Holger
Waechter, Christian
Luesebrink, Ulrich
Divchev, Dimitar
Schuett, Harald
Tsalouchidou, Panagiota-Eleni
Jerrentrup, Andreas
Parahuleva, Mariana
Schieffer, Bernhard
Karatolios, Konstantinos
Comparison of Mechanical Support with Impella or Extracorporeal Life Support in Post-Cardiac Arrest Cardiogenic Shock: A Propensity Scoring Matching Analysis
title Comparison of Mechanical Support with Impella or Extracorporeal Life Support in Post-Cardiac Arrest Cardiogenic Shock: A Propensity Scoring Matching Analysis
title_full Comparison of Mechanical Support with Impella or Extracorporeal Life Support in Post-Cardiac Arrest Cardiogenic Shock: A Propensity Scoring Matching Analysis
title_fullStr Comparison of Mechanical Support with Impella or Extracorporeal Life Support in Post-Cardiac Arrest Cardiogenic Shock: A Propensity Scoring Matching Analysis
title_full_unstemmed Comparison of Mechanical Support with Impella or Extracorporeal Life Support in Post-Cardiac Arrest Cardiogenic Shock: A Propensity Scoring Matching Analysis
title_short Comparison of Mechanical Support with Impella or Extracorporeal Life Support in Post-Cardiac Arrest Cardiogenic Shock: A Propensity Scoring Matching Analysis
title_sort comparison of mechanical support with impella or extracorporeal life support in post-cardiac arrest cardiogenic shock: a propensity scoring matching analysis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8396971/
https://www.ncbi.nlm.nih.gov/pubmed/34441879
http://dx.doi.org/10.3390/jcm10163583
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