Vasopressors and Inotropes as Predictors of Mortality in Acute Severe Cardiogenic Shock Treated With the Impella Device |
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| Institution: | 1. Anesthesia and Critical Care, Azienda Sanitaria Universitaria Integrata di Trieste, Hospital of Trieste, Strada di Fiume 447, 34149 Trieste, TS, Italy;2. Department of Emergency Medicine, UMPC University of Pittsburgh, USA;3. Anethesia and Intensive Care, St Bortolo Hospital of Vicenza, Italy;1. Acute Mechanical Circulatory Support Group, Tufts Medical Center, Boston, MA, United States of America;2. Einstein Medical Center, Philadelphia, PA, United States of America;3. Medical College of Georgia, Augusta University, Albany, GA, United States of America;4. Massachusetts General Hospital, Boston, MA, United States of America;5. Henry Ford Hospital, Detroit, MI, United States of America;1. Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany;2. Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany;3. Department of Cardiology, Odense University Hospital, Odense, Denmark;4. Advanced Heart Failure and Mechanical Circulatory Support Program, San Raffaele University, Milan, Italy;5. Department of CardioThoracic and Vascular Anesthesia and Intensive Care, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy;6. Technische Universität Dresden, Campus Chemnitz, Klinikum Chemnitz gGmbH, Chemnitz, Germany;7. Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France;8. Farmington, NM, United States;9. Banner University Medicine Cardiology Clinic, Phoenix, AZ, United States;10. Wellstar, GA, United States;11. Ascension, Warren, MI, United States;12. University Cardiology Associates, Augusta, GA, United States;13. Division of Cardiology, Abiomed Inc., Danvers, MA, United States;14. Department of Cardiovascular Medicine, Northside Cardiovascular Institute, Atlanta, GA, United States;15. Cardiovascular Research Foundation, New York, NY, United States;p. Columbia University Medical Center, New York, NY, United States;q. Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, United States;r. Henry Ford Medical Center, Department of Interventional Cardiology and Structural Heart, Detroit, MI, United States;s. The Cardiovascular Center, Tufts Medical Center, Boston, MA, United States;t. St Francis Heart Center, Roslyn, New York, NY, United States |
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| Abstract: | BackgroundVasopressors 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.MethodsThis 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.ResultsAll-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.ConclusionsThe 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. |
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