Cardiogenic shock: incidence, survival and mechanical circulatory support usage 2007\u20132017-insights from a national registry

Corinna N Lang,Torben Pottgiesser,Viviane Zotzmann,Bonaventura Schmid,Dawid L Staudacher,Daniel Duerschmied,Klaus Kaier,Constantin Von Zur Muehlen,Tobias Wengenmayer,Christoph Bode,Peter Stachon,Manfred Zehender

doi:10.1007/s00392-020-01781-z

Corinna N Lang, Torben Pottgiesser + Show 10 more

Open Access

https://doi.org/10.1007/s00392-020-01781-z

Copy DOI

Abstract

BackgroundA central element in the management of cardiogenic shock (CS) comprises mechanical circulatory support (MCS) systems to maintain cardiac output (CO). This study aims to quantify incidence, outcome and influence of MCS in CS over the last decade.MethodsAll patients hospitalized with CS in a tertiary university hospital in Germany between 2007 and 2017 were identified utilizing the international coding system ICD-10 with code R57.0. Application of MCS was identified via German procedure classification codes (OPS).Results383,983 cases of cardiogenic shock were reported from 2007 to 2017. Patients had a mean age of 71 years and 38.5% were female. The incidence of CS rose by 65.6% from 26,828 cases in 2007 (33.1 per 100,000 person-years, hospital survival 39.2%) to 44,425 cases in 2017 (53.7 per 100,000 person-years, survival 41.2%). In 2007, 16.0% of patients with CS received MCS (4.6 per 100,000 person-years, survival 46.6%), dropping to 13.9% in 2017 (6.6 per 100,000 person-years, survival 38.6%). Type of MCS changed over the years, with decreasing use of the intra-aortic balloon pump (IABP), an increase in extracorporeal membrane oxygenation (VA-ECMO) and percutaneous ventricular assist device (pVAD) usage. Significant differences regarding in-hospital survival were observed between the devices (survival: overall: 40.2%; medical treatment = 39.5%; IABP = 49.5%; pVAD = 36.2%; VA-ECMO = 30.5%; p < 0.001).ConclusionsThe incidence of CS is increasing, but hospital survival remains low. MCS was used in a minority of patients, and the percentage of MCS usage in CS has decreased. The use rates of the competing devices change over time.Graphical

Highlights

Oxygen supply and oxygen demand are mismatched in cardiogenic shock (CS) as the most severe manifestation of acute heart failure due to an impaired cardiac output (CO)
Since 2005, data on all hospitalizations in Germany have been available for scientific use via the diagnosis-related group (DRG) statistics collected by the Research Data Center of the Federal Bureau of Statistics (DESTATIS)
A total of 383,983 patients with reported CS could be identified within the analyzed time period from 2007 to 2017

Summary

Introduction

Oxygen supply and oxygen demand are mismatched in cardiogenic shock (CS) as the most severe manifestation of acute heart failure due to an impaired cardiac output (CO). Recent papers hint at present high numbers of non-ischemic shock scenarios (up to 52%)[4] They may result from pulmonary embolism, pericardial tamponade, myocarditis, arrhythmia, valvular disease, decompensated congestive heart failure or other cardiomyopathies (peripartal, autoimmune, stress induced) [5, 6]. In 2007, 16.0% of patients with CS received MCS (4.6 per 100,000 person-years, survival 46.6%), dropping to 13.9% in 2017 (6.6 per 100,000 person-years, survival 38.6%). Type of MCS changed over the years, with decreasing use of the intra-aortic balloon pump (IABP), an increase in extracorporeal membrane oxygenation (VA-ECMO) and percutaneous ventricular assist device (pVAD) usage. The use rates of the competing devices change over time

Objectives

Methods

Results

Discussion

Conclusion