Abstract
Background Although scoring systems are widely used to predict outcomes in postcardiac arrest cardiogenic shock (CS) after out-of-hospital cardiac arrest (OHCA) complicating acute myocardial infarction (AMI), data concerning the accuracy of these scores to predict mortality of patients treated with Impella in this setting are lacking. Thus, we aimed to evaluate as well as to compare the prognostic accuracy of acute physiology and chronic health II (APACHE II), simplified acute physiology score II (SAPS II), sepsis-related organ failure assessment (SOFA), the intra-aortic balloon pump (IABP), CardShock, the prediction of cardiogenic shock outcome for AMI patients salvaged by VA-ECMO (ENCOURAGE), and the survival after venoarterial extracorporeal membrane oxygenation (SAVE) score in patients with OHCA refractory CS due to an AMI treated with Impella 2.5 or CP. Methods Retrospective study of 65 consecutive Impella 2.5 and 32 CP patients treated in our cardiac arrest center from September 2015 until June 2020. Results Overall survival to discharge was 44.3%. The expected mortality according to scores was SOFA 70%, SAPS II 90%, IABP shock 55%, CardShock 80%, APACHE II 85%, ENCOURAGE 50%, and SAVE score 70% in the 2.5 group; SOFA 70%, SAPS II 85%, IABP shock 55%, CardShock 80%, APACHE II 85%, ENCOURAGE 75%, and SAVE score 70% in the CP group. The ENCOURAGE score was the most effective predictive model of mortality outcome presenting a moderate area under the curve (AUC) of 0.79, followed by the CardShock, APACHE II, IABP, and SAPS score. These derived an AUC between 0.71 and 0.78. The SOFA and the SAVE scores failed to predict the outcome in this particular setting of refractory CS after OHCA due to an AMI. Conclusion The available intensive care and newly developed CS scores offered only a moderate prognostic accuracy for outcomes in OHCA patients with refractory CS due to an AMI treated with Impella. A new score is needed in order to guide the therapy in these patients.
Highlights
Postcardiac arrest cardiogenic shock (CS) after out-of-hospital cardiac arrest (OHCA) complicating acute myocardial infarction (AMI) remains associated with a very poor prognosis, despite improvements in prehospital management and progress of postresuscitation care [1,2,3]
Little is known about the management of patients treated with Impella in terms of survival prediction or survival with good neurological outcome. e most Journal of Interventional Cardiology available scoring systems for survival after intensive care unit (ICU) admission, such as Acute Physiology and Chronic Health Score II (APACHE II), Simplified Acute Physiology Score II (SAPS II), and the sepsis-related organ failure assessment score (SOFA) have been used only sparsely in previous studies
From September 2015 to June 2020, a total of 97 consecutive patients who had postcardiac arrest CS related to AMI and underwent Impella implantation for left ventricle (LV) mechanical assistance and percutaneous coronary intervention (PCI) were included in the present retrospective analysis. e 2.5 group consisted of 65 patients, whereas the group of CP consisted of 32 patients. e mean age of our Impella 2.5 cohort was 67.86 ± 12.82 years and of our Impella CP was 66 ± 13.92 years, with survivors being significantly younger (p < 0.001 in both groups), while 84.6% (55/65) in Impella 2.5 and 63% (20/32) in Impella CP were male without any difference in the distribution among survivors or nonsurvivors
Summary
Postcardiac arrest cardiogenic shock (CS) after out-of-hospital cardiac arrest (OHCA) complicating acute myocardial infarction (AMI) remains associated with a very poor prognosis, despite improvements in prehospital management and progress of postresuscitation care [1,2,3]. Scoring systems are widely used to predict outcomes in postcardiac arrest cardiogenic shock (CS) after outof-hospital cardiac arrest (OHCA) complicating acute myocardial infarction (AMI), data concerning the accuracy of these scores to predict mortality of patients treated with Impella in this setting are lacking. Us, we aimed to evaluate as well as to compare the prognostic accuracy of acute physiology and chronic health II (APACHE II), simplified acute physiology score II (SAPS II), sepsisrelated organ failure assessment (SOFA), the intra-aortic balloon pump (IABP), CardShock, the prediction of cardiogenic shock outcome for AMI patients salvaged by VA-ECMO (ENCOURAGE), and the survival after venoarterial extracorporeal membrane oxygenation (SAVE) score in patients with OHCA refractory CS due to an AMI treated with Impella 2.5 or CP. A new score is needed in order to guide the therapy in these patients
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