Comparison of mechanical circulatory support with venoarterial extracorporeal membrane oxygenation or Impella for patien
- PDF / 807,408 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 73 Downloads / 192 Views
ORIGINAL PAPER
Comparison of mechanical circulatory support with venoarterial extracorporeal membrane oxygenation or Impella for patients with cardiogenic shock: a propensity-matched analysis Konstantinos Karatolios1 · Georgios Chatzis2 · Birgit Markus1 · Ulrich Luesebrink1 · Holger Ahrens1 · Dimitar Divchev1 · Styliani Syntila1 · Andreas Jerrentrup2 · Bernhard Schieffer1 Received: 6 June 2020 / Accepted: 30 October 2020 © The Author(s) 2020
Abstract Background Percutaneous mechanical circulatory devices are increasingly used in patients with cardiogenic shock (CS). As evidence from randomized studies comparing these devices are lacking, optimal choice of the device type is unclear. Here we aim to compare outcomes of patients with CS supported with either Impella or vaECMO. Methods Retrospective single-center analysis of patients with CS, from September 2014 to September 2019. Patients were assisted with either Impella 2.5/CP or vaECMO. Patients supported ultimately with both devices were analyzed according to the first device implanted. Primary outcomes were hospital and 6-month survival. Secondary endpoints were complications. Survival outcomes were compared using propensity-matched analysis to account for differences in baseline characteristics between both groups. Results A total of 423 patients were included (Impella, n = 300 and vaECMO, n = 123). Survival rates were similar in both groups (hospital survival: Impella 47.7% and vaECMO 37.3%, p = 0.07; 6-month survival Impella 45.7% and vaECMO 35.8%, p = 0.07). There was no significant difference in survival rates, even after adjustment for baseline differences (hospital survival: Impella 50.6% and vaECMO 38.6%, p = 0.16; 6-month survival Impella 45.8% and vaECMO 38.6%, p = 0.43). Access-site bleeding and leg ischemia occurred more frequently in patients with vaECMO (17% versus 7.3%, p = 0.004; 17% versus 7.7%, p = 0.008). Conclusions In this retrospective analysis of patients with CS, treatment with Impella 2.5/CP or vaECMO was associated with similar hospital and 6-month survival rates. Device-related access-site vascular complications occurred more frequently in the vaECMO group. A randomized trial is warranted to examine the effects of these devices on outcomes and to determine the optimal device choice in patients with CS. Keywords Mechanical circulatory support · Venoarterial extracorporeal membrane oxygenation · Impella · Cardiogenic shock
Introduction
Konstantinos Karatolios and Georgios Chatzis have been contributed equally to this work. * Konstantinos Karatolios [email protected]‑marburg.de 1
Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, BaldingerStr., 35043 Marburg, Germany
Department of Emergency Medicine, Philipps University Marburg, Marburg, Germany
2
Despite the increased use of evidence-based medicine and interventions, CS still portends unacceptably high hospital mortality rates. Percutaneous mechanical circulatory support (MCS) devices are increasingly used in patients wi
Data Loading...
