Utilization of Combined Mechanical Circulatory Support Devices in Cardiogenic Shock: Insights from the National Inpatient Sample

Abstract

Purpose Percutaneous mechanical circulatory support (MCS) devices are used in patients with cardiogenic shock (CS). In cases of incessant ventricular arrhythmias or biventricular failure these devices are used in combination. We studied the trend and mortality outcome of single vs combined MCS devices in patients with CS from the National Inpatient Sample (NIS). Methods We queried the NIS database from 2010 to 2015 for patients admitted with CS, and divided them in ischemic (ICM) and non-ischemic etiology (NICM). Implantation of MCS [Intra-aortic Balloon Pump (IABP), Extracorporeal membrane oxygenation (ECMO), Impella or Tandem Heart pVAD] were identified using appropriate ICD-9 codes. Each cohort was divided into 2 subgroups: single device (IABP or pVAD or ECMO) vs combined (or sequential) MCS (IABP+ECMO or IABP+pVAD or pVAD+ECMO) use. We analyzed trends in use and in-hospital mortality with different type of combined MCS. Results Total of 6,11,170 patients were admitted with diagnosis of CS; out of which 21.9% underwent single MCS and 1.3% underwent combined MCS device. In-hospital mortality was higher in combined MCS vs single MCS use in both ischemic (51.1% vs 20.1%; p Conclusion We observed an increase in utilization of ECMO+pVAD during the study period 2010-2015. Combined use of MCS was associated with higher in-hospital mortality in both ICM and NICM in comparison to single MCS use. Further studies are needed to validate these outcomes and to determine associated risk factors.