Abstract 240: Concomitant Use of Therapeutic Hypothermia with Mechanical Circulatory Support in Patients Post Cardiac Arrest in Cardiogenic Shock: A Single Center Experience

Abstract

Background: The concurrent use of therapeutic hypothermia (TH) following cardiac arrest and mechanical circulatory support (MCS) for cardiogenic shock is becoming increasingly common. Little is known however, about the combined use of TH and MCS for patients after ROSC following a cardiac arrest who remain in cardiogenic shock. Therefore we describe the experience with concomitant use of TH and MCS from a large academic tertiary care center in Boston. Methods: Baseline characteristics and clinical outcomes at hospital discharge were reported for patients undergoing TH following cardiac arrest who also received MCS for cardiogenic shock. MCS included Intra-aortic balloon pump (IABP) two percutaneous ventricular assist devices (Impella, and TandemHeart), and extracorporeal membrane oxygenation (ECMO). Clinical outcomes included mortality as well as cerebral performance category (CPC) at hospital discharge. Results: There were a total of 14 patients who underwent concomitant TH and MCS following a cardiac arrest. Baseline characteristics and clinical outcomes are noted in the Figure. 9 patients underwent placement of IABP, 2 patients an Impella pump, 2 patients a TandemHeart, and 1 patient ECMO. All 14 cardiac arrests were due to cardiovascular etiologies; 9 of 14 had STEMI. 9 of 14 patients had an initial shockable rhythm. Mean age was 56 years (+/- 19), mean downtime was 35 minutes (+/- 24). All patients were vasopressor dependent. Bleeding events are noted in the table. 8 patients survived to hospital discharge, all with good neurologic outcome. These rates were comparable to the survival rates and neurologic outcomes among 82 patients who underwent TH post cardiac arrest (from cardiovascular etiologies) without concomitant MCS (Figure). Conclusion: Based on our experience from a large academic tertiary care center, concomitant use of TH and MCS is both safe and feasible with an encouraging rate of cardiac and neurologic recovery.