Association of Time on Temporary Circulatory Support with Resolvement of Hemometabolic Shock

Abstract

Purpose To study the impact of temporary circulatory support (TCS) on hemometabolic shock and the relation between the duration of TCS and resulting markers of end-organ function. Methods We studied 45 patients with acute cardiogenic shock (median age 57 (IQR 49-65), 84% male) treated with TCS (59% VA ECMO, 41% temporary LVAD) as a bridge to durable LVAD implantation. Laboratory parameters of end-organ function and perfusion (AST, ALT, lactates and eGFR) were measured/calculated at onset and end of TCS. Adjusted associations between time on TCS and laboratory parameters were plotted using multivariable restricted cubic splines models with three knots. Results The median time on TCS was 7 days (IQR 4-20). One- and three-month survival following durable LVAD was 85% and 80%, respectively; median time to hospital discharge was 74 days (IQR 55-106). Median AST decreased from 300 (74-1494) to 61 U/l (32-117, p Conclusion In addition to a substantial improvement in markers of end-organ function, we have observed a significant relation between the time on TCS, lactates and in particular AST/ALT following TCS, as opposed to eGFR. The first 6-10 days of support were associated with normalisation of AST and ALT values post TCS, respectively. An analysis of a larger cohort should allow to study the association of these changes with survival.