Impella support compared to medical treatment for post-cardiac arrest shock after out of hospital cardiac arrest
Karatolios K, Chatzis G, Markus B, Luesebrink U, Ahrens H, Dersch W, Betz S, Ploeger B, Boesl E, O'Neill W, Kill C, Schieffer B. Impella support compared to medical treatment for post-cardiac arrest shock after out of hospital cardiac arrest. Resuscitation. Mar 6 2018;126(Epub ahead of print):104-110.
AIMS: To compare survival outcomes of Impella support and medical treatment in patients with post-cardiac arrest cardiogenic shock related to acute myocardial infarction (AMI).
METHODS: Retrospective single center study of patients resuscitated from out of hospital cardiac arrest (OHCA) due to AMI with post-cardiac arrest cardiogenic shock between September 2014 and September 2016. Patients were either assisted with Impella or received medical treatment only. Survival outcomes were compared using propensity score-matched analysis to account for differences in baseline characteristics between both groups.
RESULTS: A total of 90 consecutive patients with post-cardiac arrest shock due to AMI were included; 27 patients in the Impella group and 63 patients in the medical treatment group. Patients with Impella support had a longer duration of low-flow time (29.54 ± 10.21 versus 17.57 ± 8.3 min, p < 0.001), higher lactate levels on admission (4.75 [IQR 3.8-11] versus 3.6 [IQR 2.6-3.9] mmol/L, p = 0.03) and lower baseline systolic LVEF (25% [IQR 25-35] versus 45% [IQR 35-51.25], p < 0.001) as compared to patients without circulatory support. After propensity score matching, patients with Impella support had a significantly higher survival to hospital discharge (65% versus 20%, p = 0.01) and 6-months survival (60% versus 20%, p = 0.02).
CONCLUSION: The results from our study suggest that Impella support is associated with significantly better survival to hospital discharge and at 6 months compared to medical treatment in OHCA patients admitted with post-cardiac arrest cardiogenic shock and AMI.
Medical Subject Headings
Aged; Aged, 80 and over; Comorbidity; Female; Heart-Assist Devices; Humans; Length of Stay; Male; Middle Aged; Organ Dysfunction Scores; Out-of-Hospital Cardiac Arrest; Propensity Score; Retrospective Studies; Shock, Cardiogenic; Time Factors; Treatment Outcome