Impact on Mortality by Number of Vasoactive Agents Used Prior to Mechanical Circulatory Support for Cardiogenic Shock

Scatola, Andrew

Impact on Mortality by Number of Vasoactive Agents Used Prior to Mechanical Circulatory Support for Cardiogenic Shock

Monday, May 20, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Andrew Scatola, MD , Zucker School of Medicine at Hofstra/Northwell - North Shore University Hospital, Manhasset, NY

Anmol Singh, MPH , Zucker School of Medicine at Hofstra/Northwell - North Shore University Hospital, Manhasset, NY

Krunalkumar Patel, M.D. , Hofstra Northwell School of Medicine - North Shore University Hospital, Philadelphia, PA

AmitKumar Patel, MD, MPH , Hofstra Northwell School of Medicine - North Shore University Hospital, Manhasset, NY

Tasveer Khawaja , Zucker School of Medicine at Hofstra/Northwell - North Shore University Hospital, Manhasset, NY

Karanbir Singh , New York Institute of Technology, Old Westbury, NY

Navleen Singh , New York Institute of Technology, Old Westbury, NY

Perwaiz M. Meraj, M.D., FSCAI , Hofstra North Shore-LIJ School of Medicine, Oyster Bay Cove, NY

Background
Initial treatment for cardiogenic shock (CS) is vasoactive agents, including inotropes and pressors. Modern treatment for CS includes use of mechanical circulatory support including venoarterial extracorporeal membrane oxygenation (VA-ECMO), left ventricular assist devices, such as the Impella and combination VA-ECMO with Impella (ECPELLA). As mechanical support is initiated, many are still treated with vasoactive agents first.

Methods
This prospective observational study (2015-2018) of patients with refractory CS requiring Impella, VA-ECMO or ECPELLA identified 85 patients. Demographics and number of vasoactive agents used were collected. Primary endpoint was the number of vasoactive agents used prior to the start of mechanical circulatory support and 30 day mortality. Secondary outcomes were survival to explant and survival to discharge.

Results
There was a numerical increase in survival to explant for 0-2 agents used vs. 3 or more (73% vs 62%; p 0.3). This increase in survival for 0-2 agents used was seen for ECPELLA alone (88% vs 58%; p 0.16) but not for Impella or VA-ECMO. Similar trends in 30 day survival and survival to discharge were seen in the total cohort and ECPELLA group.

Conclusions
Lower use use of vasoactive agents was numerically associated with improved mortality but did not reach statistical significance. We hypothesize that this lack of difference is due to small sample size, and that a larger, trial is necessary to better assess if fewer vasoactive agents would increase survival for patients in CS.