Abstract 126: An Interdisciplinary Institutional Algorithm for the Initiation of Mechanical Circulatory Support for Acute Cardiogenic Shock
Introduction. The application of mechanical circulatory support (MCS) for refractory acute cardiogenic shock (aCS) has significantly improved survival in a group of patients that previously faced a very grim outcome. Survival is predicated on timely diagnosis and implementation of MCS after the initial injury. Within our own institution we devised a multidisciplinary algorithm created in conjunction with cardiology, emergency medicine, interventional cardiology, and cardiac surgery to streamline this process. Recently, we applied a “hub and spoke” approach to coordinating and managing the safe transfer of these patients from minimally equipped and experienced outlying hospitals to our own institution.
Hypothesis. Does implementing an interdisciplinary institutional algorithm for the initiation of MCS for acute myocardial infarction improve survival for patients with refractory aCS?
Methods. Data from all patients with aCS who underwent implantation of biventricular assist devices (n = 25) at the University of Rochester (UR) between January 2006 and December 2011 were retrospectively reviewed.
Results. Eight patients from the UoR and 17 patients transferred from outside hospitals (OSH) to our institution were placed on biventricular support for aCS. Ten biventricular Centrimag extracorporeal assist devices (BiVAD) and 15 Hybrid (HeartMate II LVAD and Centrimag extracorporeal RVAD) were placed. The UR group implemented initial therapy within 0 days of onset of symptoms vs 0.47 days (range 0-7) in the OSH group. The timing from first treatment to VAD insertion and onset of symptoms to VAD insertion was 1.38 days (range 0-5) in both UR groups versus 2.47 (range 0-7) and 2.98 days (range 0-7) respectively in the OSH groups. The UR group had a 50% survival to discharge rate while the OSH group had a 71% survival to discharge. The Hybrid group had a 93.33% survival to discharge. Overall 1-year survival after explant was 81%.
Conclusion. Early MCS implementation after refractory aCS with the Hybrid approach has a significant impact on survival to discharge and 1 year survival regardless of where the patient presented. When compared to the SHOCK trial these results offer a treatment algorithm with a reproducible technique that improves survival.
- Artificial heart/Cardiac support devices
- Cardiopulmonary resuscitation
- Acute coronary syndromes
- Ventricular assist devices
- Systems of care
- © 2012 by American Heart Association, Inc.