David D Berg1, Christopher F Barnett2, Benjamin B Kenigsberg2, Alexander Papolos2, Carlos L Alviar3, Vivian M Baird-Zars1, Gregory W Barsness4, Erin A Bohula1, Joseph Brennan5, James A Burke6, Anthony P Carnicelli7, Sunit-Preet Chaudhry8, Paul C Cremer9, Lori B Daniels10, Andrew P DeFilippis11, Daniel A Gerber12, Christopher B Granger7, Steven Hollenberg13, James M Horowitz3, James D Gladden4, Jason N Katz14, Ellen C Keeley15, Norma Keller3, Michael C Kontos16, Patrick R Lawler17, Venu Menon8, Thomas S Metkus18, P Elliott Miller5, Jose Nativi-Nicolau19, L Kristin Newby7, Jeong-Gun Park1, Nicholas Phreaner10, Robert O Roswell20, Steven P Schulman18, Shashank S Sinha21, R Jeffrey Snell22, Michael A Solomon23, Jeffrey J Teuteberg12, Wayne Tymchak24, Sean van Diepen24, David A Morrow1. 1. Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.D.B., V.M.B.-Z., E.A.B., J.-G.P., D.A.M.). 2. Medstar Heart and Vascular Institute, Medstar Washington Hospital Center, Washington DC (C.F.B., B.B.K., A.P.). 3. Leon H. Charney Division of Cardiology, New York University School of Medicine (C.L.A., J.M.H., N.K.). 4. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (G.W.B., J.D.G.). 5. Department of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (J.B., P.E.M.). 6. Lehigh Valley Health Network, Allentown, PA (J.A.B.). 7. Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.P.C., C.B.G., L.K.N.). 8. Department of Cardiology, St Vincent Hospital, Indianapolis, IN (S.-P.C., V.M.). 9. Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (P.C.C.). 10. Sulpizio Cardiovascular Center, University of California San Diego, La Jolla (L.B.D., N.P.). 11. Division of Cardiovascular Medicine, University of Louisville, KY (A.P.D.). 12. Department of Medicine, Stanford University School of Medicine, CA (D.A.G., J.J.T.). 13. Department of Cardiovascular Disease, Cooper University Hospital, Camden, NJ (S.H.). 14. Divisions of Cardiology and Pulmonary and Critical Care Medicine, University of North Carolina, Center for Heart and Vascular Care, Chapel Hill (J.N.K.). 15. Division of Cardiology, University of Florida, Gainesville (E.C.K.). 16. Division of Cardiology, Virginia Commonwealth University, Richmond (M.C.K.). 17. Division of Cardiology and Interdepartmental Division of Critical Care Medicine, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, ON (P.R.L.). 18. Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (T.S.M., S.P.S.). 19. Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City (J.N.-N.). 20. Lenox Hospital, Northwell Health, New York, NY (R.O.R.). 21. Inova Heart and Vascular Institute, Inova Fairfax Medical Center, Falls Church, VA (S.S.S.). 22. Rush University Medical Center, Chicago, IL (J.S.). 23. Critical Care Medicine Department, National Institutes of Health Clinical Center and Cardiovascular Branch, National Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda, MD (M.A.S.). 24. Department of Critical Care and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada (W.T., S.v.D.).
Abstract
BACKGROUND: Temporary mechanical circulatory support (MCS) devices provide hemodynamic assistance for shock refractory to pharmacological treatment. Most registries have focused on single devices or specific etiologies of shock, limiting data regarding overall practice patterns with temporary MCS in cardiac intensive care units. METHODS: The CCCTN (Critical Care Cardiology Trials Network) is a multicenter network of tertiary CICUs in North America. Between September 2017 and September 2018, each center (n=16) contributed a 2-month snapshot of consecutive medical CICU admissions. RESULTS: Of the 270 admissions using temporary MCS, 33% had acute myocardial infarction-related cardiogenic shock (CS), 31% had CS not related to acute myocardial infarction, 11% had mixed shock, and 22% had an indication other than shock. Among all 585 admissions with CS or mixed shock, 34% used temporary MCS during the CICU stay with substantial variation between centers (range: 17%-50%). The most common temporary MCS devices were intraaortic balloon pumps (72%), Impella (17%), and veno-arterial extracorporeal membrane oxygenation (11%), although intraaortic balloon pump use also varied between centers (range: 40%-100%). Patients managed with intraaortic balloon pump versus other forms of MCS (advanced MCS) had lower Sequential Organ Failure Assessment scores and less severe metabolic derangements. Illness severity was similar at high- versus low-MCS utilizing centers and at centers with more advanced MCS use. CONCLUSIONS: There is wide variation in the use of temporary MCS among patients with shock in tertiary CICUs. While hospital-level variation in temporary MCS device selection is not explained by differences in illness severity, patient-level variation appears to be related, at least in part, to illness severity.
BACKGROUND: Temporary mechanical circulatory support (MCS) devices provide hemodynamic assistance for shock refractory to pharmacological treatment. Most registries have focused on single devices or specific etiologies of shock, limiting data regarding overall practice patterns with temporary MCS in cardiac intensive care units. METHODS: The CCCTN (Critical Care Cardiology Trials Network) is a multicenter network of tertiary CICUs in North America. Between September 2017 and September 2018, each center (n=16) contributed a 2-month snapshot of consecutive medical CICU admissions. RESULTS: Of the 270 admissions using temporary MCS, 33% had acute myocardial infarction-related cardiogenic shock (CS), 31% had CS not related to acute myocardial infarction, 11% had mixed shock, and 22% had an indication other than shock. Among all 585 admissions with CS or mixed shock, 34% used temporary MCS during the CICU stay with substantial variation between centers (range: 17%-50%). The most common temporary MCS devices were intraaortic balloon pumps (72%), Impella (17%), and veno-arterial extracorporeal membrane oxygenation (11%), although intraaortic balloon pump use also varied between centers (range: 40%-100%). Patients managed with intraaortic balloon pump versus other forms of MCS (advanced MCS) had lower Sequential Organ Failure Assessment scores and less severe metabolic derangements. Illness severity was similar at high- versus low-MCS utilizing centers and at centers with more advanced MCS use. CONCLUSIONS: There is wide variation in the use of temporary MCS among patients with shock in tertiary CICUs. While hospital-level variation in temporary MCS device selection is not explained by differences in illness severity, patient-level variation appears to be related, at least in part, to illness severity.
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