Percutaneous left ventricular assist support is associated with less pulmonary congestion and lower rate of pneumonia in patients with cardiogenic shock

• Published in: Open heart 2020-11, Vol.7 (2), p.e001385
• Main Authors: Haberkorn, Sandra, Uwarow, Angelika, Haurand, Jean, Jung, Christian, Kelm, Malte, Westenfeld, Ralf, Horn, Patrick
• Format: Article
• Language: English
• Subjects: Aged; Antibiotics; Blood pressure; Coronary vessels; Edema; Female; Heart attacks; Heart Failure and Cardiomyopathies; Heart-Assist Devices; Humans; Intra-Aortic Balloon Pumping - adverse effects; Intra-Aortic Balloon Pumping - mortality; Laboratories; Male; Middle Aged; Mortality; Normal distribution; Patients; Pneumonia; Pneumonia - diagnosis; Pneumonia - mortality; Pneumonia - physiopathology; Pneumonia - prevention & control; Prosthesis Implantation - adverse effects; Prosthesis Implantation - instrumentation; Prosthesis Implantation - mortality; Pulmonary arteries; Pulmonary Edema - diagnosis; Pulmonary Edema - mortality; Pulmonary Edema - physiopathology; Pulmonary Edema - prevention & control; Retrospective Studies; Risk Assessment; Risk Factors; Shock, Cardiogenic - diagnosis; Shock, Cardiogenic - mortality; Shock, Cardiogenic - physiopathology; Shock, Cardiogenic - therapy; Time Factors; Treatment Outcome; Veins & arteries; Ventricular Function, Left; X-rays
• ISSN: 2053-3624; 2398-595X; 2053-3624
• DOI: 10.1136/openhrt-2020-001385

ObjectivesThe aim of this study was to investigate the impact of acute left ventricular unloading by percutaneous left ventricular assist device on pulmonary congestion and pneumonia in patients with cardiogenic shock (CS).MethodsIn this retrospective study, we analysed patients with CS who received the Impella percutaneous left ventricular assist device (n=50) compared with those who received intra-aortic balloon pump (IABP) support (n=50). Pulmonary congestion was longitudinally assessed while on support by calculating characteristic findings on the chest X-ray using the Halperin score. The rate of pneumonia and early mortality were assessed as a secondary endpoint.ResultsThe groups (Impella vs IABP) did not differ in terms of age, Sequential Organ Failure Assessment (SOFA) score, Acute Physiology, Chronic Health Evaluation (APACHE) II score or serum lactate levels. Pulmonary congestion decreased in patient treated with Impella at each time point postimplantation. No change in congestion status was observed in patients supported with IABP. Multivariate analysis indicated Impella support as an independent predictor for pulmonary decongestion (OR 4.06, 95% CI 1.15 to 14.35, p=0.030). The rate of early pneumonia was lower in the Impella group compared with the IABP group (54% vs 74%, p=0.037). Failure of pulmonary decongestion during mechanical circulatory support independently predicted early pneumonia (OR 0.28, 95% CI 0.12 to 0.70, p=0.006).ConclusionPulmonary decongestion may facilitate treatment of pneumonia in patients with CS. Left ventricular unloading by Impella device might support pulmonary decongestion, although a larger prospective trial in this patient population is required.