AIMS: Cardiogenic shock is still associated with high mortality rates of around 50%. Intra-aortic counterpulsation had been frequently used in cardiogenic shock, but was previously found to provide no mortality benefit. We investigated the effect of an interdisciplinary and multiprofessional routine strategy of early invasive haemodynamic support in combination with complete revascularization in patients with cardiogenic shock before admission to our intensive care unit. METHODS AND RESULTS: We analysed all cardiogenic shock patients (mean age 62±13 years) presenting at our institution between 2013 and mid 2016, who received an Impella CP microaxial pump for isolated left ventricle support (n=61). Sixty-one per cent (n=37) had been resuscitated before Impella insertion. Overall mortality was 48% (n=29/61) at 30 days. Thirty-day mortality was higher in resuscitated patients (resuscitated: 65% (n=24/37); non-resuscitated: 21% (n=5/24)). When applying the inclusion/exclusion criteria of the SHOCK-II trial, eligible patients (n=25) had a markedly lower mortality (24% (n=6/25) at 30 days) compared with the published trial (~40% in both arms). The observed mortality of SHOCK-II-like patients in the registry was also lower compared with their predicted mortality using IABP-Shock II score (49%) and CardShock score (36%). CONCLUSION: The results of this registry suggest that using a standardized protocol including early active haemodynamic support with Impella CP in cardiogenic shock in patients with isolated left ventricle failure may be associated with improved outcomes and lower than previously reported or predicted mortality rates. Pre-implantation cardiac arrest critically influences observed mortality. The results support the case for a randomized trial.
AIMS: Cardiogenic shock is still associated with high mortality rates of around 50%. Intra-aortic counterpulsation had been frequently used in cardiogenic shock, but was previously found to provide no mortality benefit. We investigated the effect of an interdisciplinary and multiprofessional routine strategy of early invasive haemodynamic support in combination with complete revascularization in patients with cardiogenic shock before admission to our intensive care unit. METHODS AND RESULTS: We analysed all cardiogenic shock patients (mean age 62±13 years) presenting at our institution between 2013 and mid 2016, who received an Impella CP microaxial pump for isolated left ventricle support (n=61). Sixty-one per cent (n=37) had been resuscitated before Impella insertion. Overall mortality was 48% (n=29/61) at 30 days. Thirty-day mortality was higher in resuscitated patients (resuscitated: 65% (n=24/37); non-resuscitated: 21% (n=5/24)). When applying the inclusion/exclusion criteria of the SHOCK-II trial, eligible patients (n=25) had a markedly lower mortality (24% (n=6/25) at 30 days) compared with the published trial (~40% in both arms). The observed mortality of SHOCK-II-like patients in the registry was also lower compared with their predicted mortality using IABP-Shock II score (49%) and CardShock score (36%). CONCLUSION: The results of this registry suggest that using a standardized protocol including early active haemodynamic support with Impella CP in cardiogenic shock in patients with isolated left ventricle failure may be associated with improved outcomes and lower than previously reported or predicted mortality rates. Pre-implantation cardiac arrest critically influences observed mortality. The results support the case for a randomized trial.
Authors: Andreas Schäfer; Nikos Werner; Daniel Burkhoff; Jan-Thorben Sieweke; Andreas Zietzer; Maryna Masyuk; Nanna Louise Junker Udesen; Ralf Westenfeld; Jacob Eifer Møller Journal: Front Cardiovasc Med Date: 2020-05-14
Authors: Vera Garcheva; Muharrem Akin; John Adel; Carolina Sanchez Martinez; Johann Bauersachs; Andreas Schäfer Journal: PLoS One Date: 2021-05-04 Impact factor: 3.240
Authors: Héctor González-Pacheco; Daniel Manzur-Sandoval; Rodrigo Gopar-Nieto; Amada Álvarez-Sangabriel; Carlos Martínez-Sánchez; Guering Eid-Lidt; Alfredo Altamirano-Castillo; Salvador Mendoza-García; José Luis Briseño-Cruz; Francisco Azar-Manzur; Diego Araiza-Garaygordobil; Daniel Sierra-Lara; Gian Manuel Jiménez-Rodríguez; Emmanuel Adrián Lazcano-Díaz; Francisco Baranda-Tovar; Jessrel Sharon Valencia-Älvarez; Miguel Alejandro Cutz-Ijchajchal; Jose Carlos Penagos-Cordon; Paola Morejon-Barragán; Alexandra Arias-Mendoza Journal: Glob Heart Date: 2021-11-30
Authors: Andreas Schäfer; Ralf Westenfeld; Jan-Thorben Sieweke; Andreas Zietzer; Julian Wiora; Giulia Masiero; Carolina Sanchez Martinez; Giuseppe Tarantini; Nikos Werner Journal: Front Cardiovasc Med Date: 2021-07-09
Authors: Jan-Thorben Sieweke; Muharrem Akin; Sebastian Stetskamp; Christian Riehle; Danny Jonigk; Ulrike Flierl; Tobias J Pfeffer; Valentin Hirsch; Jochen Dutzmann; Marius M Hoeper; Christian Kühn; Johann Bauersachs; Andreas Schäfer Journal: Eur Respir J Date: 2020-09-03 Impact factor: 16.671