Mechanical Circulatory Support Following Out-of-Hospital Cardiac Arrest: Insights From the National Cardiogenic Shock Initiative.
Publication/Presentation Date
11-1-2021
Abstract
BACKGROUND: Evidence is limited regarding the role of mechanical circulatory support (MCS) in patients with acute coronary syndromes (ACS) complicated by cardiogenic shock (CGS). In particular, the role of MCS in patients with out-of-hospital cardiac arrest (OHCA) is unknown.
METHODS: The National Cardiogenic Shock Initiative (NCSI) is a multicenter United States registry of patients with ACS complicated by CGS treated with MCS. We compared the rate of survival to hospital discharge among patients with OHCA, in-hospital cardiac arrest (IHCA), or no cardiac arrest. We subsequently used multivariable analyses to determine independent predictors of OHCA survival.
RESULTS: Survival to hospital discharge occurred in 85.7% (42/49) of OHCA, 72.4% (50/69) of IHCA, and 74.5% (111/149) of non-cardiac arrest patients. By multivariable analysis, pre-procedural predictors of survival included younger age, female sex, fewer diseased vessels, left anterior descending coronary artery culprit, lower troponin, higher lactate, and delayed initiation of MCS. Procedural and post-procedural predictors of survival included fewer vessels treated, complete revascularization, higher post-MCS cardiac power output, and fewer inotropic medications required.
CONCLUSIONS: This study demonstrates that excellent outcomes may be achieved following OHCA when MCS is employed for patients appropriately selected by prognostic demographic, anatomic, and health status characteristics. A larger study population, currently being enrolled, is needed to validate the observation further.
Volume
32
First Page
58
Last Page
62
ISSN
1878-0938
Published In/Presented At
Goldsweig, A. M., Tak, H. J., Alraies, M. C., Park, J., Smith, C., Baker, J., Lin, L., Patel, N., O'Neill, W. W., Basir, M. B., & National Cardiogenic Shock Initiative Investigators (2021). Mechanical Circulatory Support Following Out-of-Hospital Cardiac Arrest: Insights From the National Cardiogenic Shock Initiative. Cardiovascular revascularization medicine : including molecular interventions, 32, 58–62. https://doi.org/10.1016/j.carrev.2020.12.021
Disciplines
Medicine and Health Sciences
PubMedID
33358390
Department(s)
Department of Medicine
Document Type
Article