"TCT-469 A Prospective Registry of Complications Associated With Tempor" by Raef Fadel, Fakilahyel Mshelbwala et al.
 

TCT-469 A Prospective Registry of Complications Associated With Temporary Mechanical Circulatory Support (The PROCTOR MCS Registry)

Document Type

Conference Proceeding

Publication Date

10-29-2024

Publication Title

J Am Coll Cardiol

Abstract

Background: Mechanical circulatory support (MCS) devices are increasingly used in the management of cardiogenic shock (CS) and are associated with high complications rates. There are no prospective studies quantifying the rates of complications across MCS devices and nursing burden of such complications. Methods: We compiled a prospective registry of patients in CS, requiring MCS, who were admitted to our quaternary care institution. Patients were enrolled in consecutive fashion for the entirety of their hospital stay, with 30-day postdischarge follow-up. A comprehensive log of patient care was maintained daily by the patient’s nursing team. Results: One hundred eighty-three patients were enrolled in the study. The median age was 64 years (Q1-Q3: 54-71 years), 62.3% were White, and 72.7% were male. The most common cause of CS was acute myocardial infarction (67.2%). The majority of patients were in stage D shock (44.3%). MCS devices used included intra-aortic balloon pump (38%), Impella CP/5.5 (Abiomed, 22.4%), venoarterial extracorporeal membrane oxygenation (22.4%), venovenous extracorporeal membrane oxygenation (8.2%), RP Impella (Abiomed, 4.9%), and EcPella (Abiomed, 3.8%). Nursing logs were completed for a median of 84% (Q1-Q3: 65%-95%) of patient care days; 26.2% of patients had Doppler loss of pulses, 5.5% required cath lab activation for acute limb ischemia, 72.7% of patients required 1 to 2 dressing changes per shift, 55.2% required 1 to 2 phone calls related to the MCS device per shift, 33.9% required 1 to 2 calls related to bleeding, 26.2% required 1 to 2 calls related to device adjustment, and 30.1% required 1 to 2 transfers out of the cardiac intensive care unit per shift. Major complications included blood transfusion (63.4%), acute kidney injury (61.2%), hemolysis (48.1%), major bleeding (27.9%), sepsis requiring antibiotics (15.8%), and stroke (10.4%). Rates of complications and phone calls per shift were all more likely in patients with large-bore MCS compared to intra-aortic balloon pump (P < 0.05). Overall in-hospital mortality was 36.6%, and 30-day mortality was 32.2%. Conclusion: This prospective registry of patients with CS treated with MCS demonstrates that the use of MCS devices is associated with high rates of complications and nursing care requirements, which are driven primarily by large-bore MCS devices. Categories: CORONARY: Hemodynamic Support, Cardiogenic Shock and Cardiac Arrest.

Volume

84

Issue

18

First Page

B152

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