Charlene L Rohm1, Bogdan Gadidov2, Herman E Ray3, Salvatore F Mannino4, Rajnish Prasad4. 1. Department of Internal Medicine, Wellstar Kennestone Regional Medical Center, Marietta, GA, USA. Electronic address: rohm.charlene@mayo.edu. 2. Analytics and Data Science Institute, Kennesaw State University, Kennesaw, GA, USA. 3. Analytics and Data Science Institute, Kennesaw State University, Kennesaw, GA, USA; Department of Statistics and Analytical Sciences, Kennesaw State University, Kennesaw, GA, USA. 4. Wellstar Cardiovascular Medicine, Wellstar Kennestone Regional Medical Center, Marietta, GA, USA.
Abstract
BACKGROUND: Vasopressors and inotropes are the primary pharmacologic agents in the management of cardiogenic shock. Increased use of these agents in the setting of cardiogenic shock treated with the Impella is associated with increased mortality. This study evaluates the use of vasopressors and inotropes as predictors of mortality in patients treated with the Impella for acute cardiogenic shock. METHODS: This retrospective study included 276 patients treated with the Impella 2.5, Impella CP, or Impella 5.0 from March 2011 to January 2020 at a single, tertiary referral center for acute cardiogenic shock. RESULTS: All-cause in-hospital mortality was 44.6%. Mortality significantly increased with escalating use of vasopressors and inotropes, with the most significant increase in mortality from use of 2 agents to the use of 3 agents (8.1% vs 39.7%, p < 0.001). There was no difference in mortality whether dobutamine or milrinone was used (44.4% vs 35.7%, p = 0.41); there was increased mortality with use of multiple inotropes. Patients treated with only vasopressors had increased mortality compared to those treated with a combination of agents that included 1 inotrope. CONCLUSIONS: The escalating need for vasopressors and inotropes and particular combinations of these agents are significant predictors of mortality that may help determine whether the Impella or higher level of support is more appropriate to treat acute cardiogenic shock.
BACKGROUND: Vasopressors and inotropes are the primary pharmacologic agents in the management of cardiogenic shock. Increased use of these agents in the setting of cardiogenic shock treated with the Impella is associated with increased mortality. This study evaluates the use of vasopressors and inotropes as predictors of mortality in patients treated with the Impella for acute cardiogenic shock. METHODS: This retrospective study included 276 patients treated with the Impella 2.5, Impella CP, or Impella 5.0 from March 2011 to January 2020 at a single, tertiary referral center for acute cardiogenic shock. RESULTS: All-cause in-hospital mortality was 44.6%. Mortality significantly increased with escalating use of vasopressors and inotropes, with the most significant increase in mortality from use of 2 agents to the use of 3 agents (8.1% vs 39.7%, p < 0.001). There was no difference in mortality whether dobutamine or milrinone was used (44.4% vs 35.7%, p = 0.41); there was increased mortality with use of multiple inotropes. Patients treated with only vasopressors had increased mortality compared to those treated with a combination of agents that included 1 inotrope. CONCLUSIONS: The escalating need for vasopressors and inotropes and particular combinations of these agents are significant predictors of mortality that may help determine whether the Impella or higher level of support is more appropriate to treat acute cardiogenic shock.
Authors: Ivan David Lozada Martinez; Andrea Juliana Bayona-Gamboa; Duvier Fabián Meza-Fandiño; Omar Andrés Paz-Echeverry; Ángela María Ávila-Bonilla; Mario Javier Paz-Echeverry; Frank Jaider Pineda-Trujillo; Gina Paola Rodríguez-García; Jaime Enrique Covaleda-Vargas; Alexis Rafael Narvaez-Rojas Journal: Ann Med Surg (Lond) Date: 2022-09-22