Title

Impella support compared to medical treatment for post-cardiac arrest shock after out of hospital cardiac arrest.

Document Type

Article

Publication Date

5-1-2018

Publication Title

Resuscitation

Abstract

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

PubMed ID

29522829

Volume

126

First Page

104

Last Page

110

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