Escalation of temporary mechanical circulatory support in the setting of deteriorating cardiogenic shock

Document Type

Conference Proceeding

Publication Date


Publication Title

Catheter Cardiovasc Interventions


Background: Cardiogenic shock (CS) is a deadly condition and mechanical circulatory support (MCS) is frequently utilized. We evaluated the characteristics of CS patients who required escalation of MCS due to deteriorating shock.

Methods: From 07/2016-07/2018 we identified consecutive CS patients with deteriorating shock requiring escalation of MCS. Deteriorating shock was defined as worsening hypotension, escalating doses of vasopressors or worsening end-organ hypoperfusion. MCS escalation was defined as adding or exchanging a MCS device to existing MCS. All statistical tests were performed with a two-sided P value=.05.

Results: 81 CS patients (61 ±14.2y, 73% men) had deteriorating shock requiring MCS escalation. 23% presented with acute myocardial infarction, 72% with decompensated heart failure (non-ischemic cardiomyopathy 26% and ischemic cardiomyopathy 46%) and 5% undifferentiated. Distribution of CS per SCAI classification was stage C 7%, D 82% and E 11%. Survival to discharge was 32%. Survivors were younger (55 vs 65y, P=0.002) and had lower BMI (29 vs 34, P=0.031). Initial MCS was IABP (n=32), Impella 2.5 (=4), CP (=32), 5.0 (=2), TandemHeart (=3), ProtekDuo (=3), VVECMO (=2), VAECMO (=2) and ProtekDuo+Impella CP (=1). Patients were escalated to Impella 2.5 (n=1), CP (=16), 5.0 (=10), TandemHeart (=6), VAECMO (=8), VAECMO+(IABP, 2.5 or CP) (=20), ProtekDuo+(IABP, CP, 5.0 or TandemHeart) (=13), Impella CP+RP (=2), TandemHeart+Impella RP (=1), central VAECMO (=3) and LVAD (=1). Lactate levels pre and post escalation were lower in survivors compared to non-survivors (3.3 vs 6.9, P=0.02) and (2 vs 4.4, P=0.01). Non-survivor lactate levels did not significantly improve post escalation (6.9 vs 4.4, P=0.06) and mean arterial pressure decreased (77.1 vs 66.8, P=0.002) despite significant improvement in cardiac index (1.9 vs 3.4, P<0.001) and cardiac power output (0.6 vs 1.1, P=0.0001). Utilization of a PA catheter preescalation was associated with improved survival (40% vs 18%, P=0.04).

Conclusions: CS patients requiring escalation of MCS due to deteriorating shock have low hospital survival (32%). Younger age, lower BMI, lower lactate levels and utilization of PA catheter pre-escalation were associated with increased survival.



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