Mechanical Circulatory Support for Patients With Acute Cardiogenic Shock.

Abstract

Purpose Mechanical circulatory support (MCS) has been used for management of patients with acute cardiogenic shock with unsatisfactory results. Recent advent of short, mid and long term support devices has provided options to choose from according to the severity of shock, other comorbiditis and social support status of patients. However, indications, timing of intervention, duration of support, is not clearly delineated. This is a descriptive study of MCS for patients with acute cardiogenic shock. Methods Patients with acute cardiogenic shock who required MCS were retrospectively analyzed. Patients on intraaortic balloon pump (IABP) were enrolled when more advanced support was required. Patients with post cardiotomy shock were not included. Results From March 2010 to September 2013, 21 patients (15 men and 6 women; mean age, 47.6 ± 13.2 years; age range 21-71 years) were enrolled in the study. Etiology included acute myocardial infarction in 3 patients, decompensation of cardiomyopathy in 17 patients and unknown in 1. INTERMACS score was 1 in 18 patients and 2 in 3 patients. Initial devices were IABP, Impella 5.0 (Abiomed Inc., Danvers, MA), ECMO with femoral cannulation, central ECMO and HeartMateII (HMII, Thoratec Corp., Pleasanton, CA) in 8, 1, 4, 6 and 2 patients, respectively. After recovery from shock, 14 patients (67%) were bridged to HMII. Of those who were bridged to HMII, eight (57%) developed right ventricular failure (RVF). Of 8 patients with RVF post HMII, three were bridged to Htx, one was discharged with HMII, and four died due to acute RVF or multiple organ failure (MOF). Overall, survival to hospital discharge was achieved in 12 patients (57%). No patients weaned from MCS. Causes of death were acute RVF, MOF and stroke in 4, 3, 2 patients, respectively. Conclusions In our experience patients with severe cardiogenic shock who required advanced MCS could not wean from support. Stabilization of shock and bridging to HMII was achievable in two thirds of patients with various MCS options. Survival to hospital discharge was 57%. Development of RVF appeared to be the major determining factor for survival.