Extracorporeal resuscitation as a further modifier of clinical outcome in patients with left ventricular assist device implantation and Interagency Registry for Mechanically Assisted Circulatory Support level 1

• Published in: Interactive cardiovascular and thoracic surgery 2018-07, Vol.27 (1), p.139-141
• Main Authors: Ljajikj, Edis, Zittermann, Armin, Koster, Andreas, Börgermann, Jochen, Schönbrodt, Michael, Hakim-Meibodi, Kavous, Gummert, Jan, Morshuis, Michiel
• Format: Article
• Language: English
• Subjects: Adult; Aged; Cardiopulmonary Resuscitation; Extracorporeal Membrane Oxygenation; Female; Heart-Assist Devices; Humans; Male; Middle Aged; Proportional Hazards Models; Registries; Shock, Cardiogenic - mortality; Shock, Cardiogenic - therapy; Survival Rate; Thoracic Surgical Procedures; Treatment Outcome
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivx433

In cardiogenic shock patients with Interagency Registry for Mechanical Circulatory Support (INTERMACS) level 1, the need for temporary circulatory support is a predictor and modifier of patient outcome. Because this group includes patients with and without cardiopulmonary resuscitation (CPR) and is thus very heterogeneous, we investigated whether a further subclassification is useful. We compared 30-day and 1-year mortality of patients who underwent left ventricular assist device implantation after extracorporeal CPR with the aid of an extracorporeal life support system (CPR+ group; n = 40) with cardiogenic shock patients in which the extracorporeal life support system was implanted under non-CPR conditions (CPR- group, n = 68). In the CPR+ and CPR- groups, 30-day mortality was 27.5% (n = 11) and 8.8% (n = 6), respectively (P = 0.014). The values for 1-year mortality were 57.5% (n = 23) and 36.8% (n = 25), respectively (P = 0.023). The age- and gender-adjusted hazard ratios of 30-day and 1-year mortality for the CPR+ group versus the CPR- group were 3.88 (95% confidence interval 1.29-11.7; P = 0.016) and 1.79 (95% confidence interval 1.01-3.17; P = 0.045), respectively. In conclusion, our data show that left ventricular assist device implantation with extracorporeal life support following CPR is associated with high 30-day and 1-year mortality. Further multicentre studies are needed to confirm these results and potentially add CPR as a new modifier to the INTERMACS profile.