Saraschandra Vallabhajosyula1,2,3, Abhiram Prasad1, Malcolm R Bell1, Gurpreet S Sandhu1, Mackram F Eleid1, Shannon M Dunlay1,4, Gregory J Schears5, John M Stulak6, Mandeep Singh1, Bernard J Gersh1, Allan S Jaffe1, David R Holmes1, Charanjit S Rihal1, Gregory W Barsness1. 1. Department of Cardiovascular Medicine (S.V., A.P., M.R.B., G.S.S., M.F.E., S.M.D., M.S., B.J.G., A.S.J., D.R.H., C.S.R., G.W.B.), Mayo Clinic, Rochester, MN. 2. Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.V.), Mayo Clinic, Rochester, MN. 3. Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN (S.V.). 4. Department of Health Science Research (S.M.D.), Mayo Clinic, Rochester, MN. 5. Division of Critical Care Anesthesiology, Department of Anesthesiology and Perioperative Medicine (G.J.S.), Mayo Clinic, Rochester, MN. 6. Department of Cardiovascular Surgery (J.M.S.), Mayo Clinic, Rochester, MN.
Abstract
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is increasingly used in acute myocardial infarction (AMI); however, there are limited large-scale national data. METHODS: Using the National Inpatient Sample database from 2000 to 2014, a retrospective cohort of AMI utilizing ECMO was identified. Use of percutaneous coronary intervention, intra-aortic balloon pump, and percutaneous left ventricular assist device (LVAD) was also identified in this population. Outcomes of interest included temporal trends in utilization of ECMO alone and with concomitant procedures (percutaneous coronary intervention, intra-aortic balloon pump, and percutaneous LVAD), in-hospital mortality, and resource utilization. RESULTS: In ≈9 million AMI admissions, ECMO was used in 2962 (<0.01%) and implanted a median of 1 day after admission. ECMO was used in 0.5% and 0.3% AMI admissions complicated by cardiogenic shock and cardiac arrest, respectively. ECMO was used more commonly in admissions that were younger, nonwhite, and with less comorbidity. ECMO use was 11× higher in 2014 as compared with 2000 (odds ratio, 11.37 [95% CI, 7.20-17.97]). Same-day percutaneous coronary intervention was performed in 23.1%; intra-aortic balloon pump/percutaneous LVAD was used in 57.9%, of which 30.3% were placed concomitantly. In-hospital mortality with ECMO was 59.2% overall but decreased from 100% (2000) to 45.1% (2014). Durable LVAD and cardiac transplantation were performed in 11.7% as an exit strategy. Of the hospital survivors, 40.8% were discharged to skilled nursing facilities. Older age, male sex, nonwhite race, and lower socioeconomic status were independently associated with higher in-hospital mortality with ECMO use. CONCLUSIONS: In AMI admissions, a steady increase was noted in the utilization of ECMO alone and with concomitant procedures (percutaneous coronary intervention, intra-aortic balloon pump, and percutaneous LVAD). In-hospital mortality remained high in AMI admissions treated with ECMO.
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is increasingly used in acute myocardial infarction (AMI); however, there are limited large-scale national data. METHODS: Using the National Inpatient Sample database from 2000 to 2014, a retrospective cohort of AMI utilizing ECMO was identified. Use of percutaneous coronary intervention, intra-aortic balloon pump, and percutaneous left ventricular assist device (LVAD) was also identified in this population. Outcomes of interest included temporal trends in utilization of ECMO alone and with concomitant procedures (percutaneous coronary intervention, intra-aortic balloon pump, and percutaneous LVAD), in-hospital mortality, and resource utilization. RESULTS: In ≈9 million AMI admissions, ECMO was used in 2962 (<0.01%) and implanted a median of 1 day after admission. ECMO was used in 0.5% and 0.3% AMI admissions complicated by cardiogenic shock and cardiac arrest, respectively. ECMO was used more commonly in admissions that were younger, nonwhite, and with less comorbidity. ECMO use was 11× higher in 2014 as compared with 2000 (odds ratio, 11.37 [95% CI, 7.20-17.97]). Same-day percutaneous coronary intervention was performed in 23.1%; intra-aortic balloon pump/percutaneous LVAD was used in 57.9%, of which 30.3% were placed concomitantly. In-hospital mortality with ECMO was 59.2% overall but decreased from 100% (2000) to 45.1% (2014). Durable LVAD and cardiac transplantation were performed in 11.7% as an exit strategy. Of the hospital survivors, 40.8% were discharged to skilled nursing facilities. Older age, male sex, nonwhite race, and lower socioeconomic status were independently associated with higher in-hospital mortality with ECMO use. CONCLUSIONS: In AMI admissions, a steady increase was noted in the utilization of ECMO alone and with concomitant procedures (percutaneous coronary intervention, intra-aortic balloon pump, and percutaneous LVAD). In-hospital mortality remained high in AMI admissions treated with ECMO.
Authors: Saraschandra Vallabhajosyula; Shilpkumar Arora; Ankit Sakhuja; Sopan Lahewala; Varun Kumar; Ghanshyam P S Shantha; Alexander C Egbe; John M Stulak; Bernard J Gersh; Rajiv Gulati; Charanjit S Rihal; Abhiram Prasad; Abhishek J Deshmukh Journal: Am J Cardiol Date: 2018-11-06 Impact factor: 2.778
Authors: Saraschandra Vallabhajosyula; Shilpkumar Arora; Sopan Lahewala; Varun Kumar; Ghanshyam P S Shantha; Jacob C Jentzer; John M Stulak; Bernard J Gersh; Rajiv Gulati; Charanjit S Rihal; Abhiram Prasad; Abhishek J Deshmukh Journal: J Am Heart Assoc Date: 2018-11-20 Impact factor: 5.501
Authors: Saraschandra Vallabhajosyula; Abhiram Prasad; Shannon M Dunlay; Dennis H Murphree; Cory Ingram; Paul S Mueller; Bernard J Gersh; David R Holmes; Gregory W Barsness Journal: J Am Heart Assoc Date: 2019-07-18 Impact factor: 5.501
Authors: Saraschandra Vallabhajosyula; Viral K Desai; Pranathi R Sundaragiri; Wisit Cheungpasitporn; Rajkumar Doshi; Vikas Singh; Allan S Jaffe; Amir Lerman; Gregory W Barsness Journal: Ann Transl Med Date: 2021-07
Authors: Saraschandra Vallabhajosyula; Saarwaani Vallabhajosyula; Shannon M Dunlay; Sharonne N Hayes; Patricia J M Best; Jorge A Brenes-Salazar; Amir Lerman; Bernard J Gersh; Allan S Jaffe; Malcolm R Bell; David R Holmes; Gregory W Barsness Journal: Mayo Clin Proc Date: 2020-09 Impact factor: 7.616
Authors: Saraschandra Vallabhajosyula; Lina Ya'Qoub; Mandeep Singh; Malcolm R Bell; Rajiv Gulati; Wisit Cheungpasitporn; Pranathi R Sundaragiri; Virginia M Miller; Allan S Jaffe; Bernard J Gersh; David R Holmes; Gregory W Barsness Journal: Circ Heart Fail Date: 2020-09-29 Impact factor: 8.790
Authors: Saraschandra Vallabhajosyula; Sri Harsha Patlolla; Dhiran Verghese; Lina Ya'Qoub; Vinayak Kumar; Anna V Subramaniam; Wisit Cheungpasitporn; Pranathi R Sundaragiri; Peter A Noseworthy; Siva K Mulpuru; Malcolm R Bell; Bernard J Gersh; Abhishek J Deshmukh Journal: Am J Cardiol Date: 2020-04-06 Impact factor: 2.778
Authors: Saraschandra Vallabhajosyula; Stephanie R Payne; Jacob C Jentzer; Lindsey R Sangaralingham; Kianoush Kashani; Nilay D Shah; Abhiram Prasad; Shannon M Dunlay Journal: Mayo Clin Proc Innov Qual Outcomes Date: 2021-02-08
Authors: Saraschandra Vallabhajosyula; Dhiran Verghese; Malcolm R Bell; Dennis H Murphree; Wisit Cheungpasitporn; Paul Elliott Miller; Shannon M Dunlay; Abhiram Prasad; Gurpreet S Sandhu; Rajiv Gulati; Mandeep Singh; Amir Lerman; Bernard J Gersh; David R Holmes; Gregory W Barsness Journal: ESC Heart Fail Date: 2021-03-11
Authors: Saraschandra Vallabhajosyula; Jacob C Jentzer; Abhiram Prasad; Lindsey R Sangaralingham; Kianoush Kashani; Nilay D Shah; Shannon M Dunlay Journal: ESC Heart Fail Date: 2021-04-09
Authors: Mir B Basir; Duane S Pinto; Boback Ziaeian; Akshay Khandelwal; Jennifer Cowger; William Suh; Andrew Althouse Journal: Catheter Cardiovasc Interv Date: 2021-03-07 Impact factor: 2.692