Abstract 16278: Outcomes of Concomitant Use of Mechanical Circulatory Support in Patients Undergoing Therapeutic Hypothermia: A Propensity Score Weighted Regression Analysis
Introduction: Use of mechanical circulatory support (MCS) is rising. There is limited data to support or refute the use of MCS in patients (pts) undergoing therapeutic hypothermia (TH).
Hypothesis: We hypothesized that use of MCS is safe in pts undergoing TH.
Methods: We retrospectively reviewed 336 consecutive pts (mean age 57.9 ± 14.9 years) treated with TH at our center from 2007-2014. We used a propensity score weighted logistic/ordinal regression analysis to identify association of MCS use with significant bleeding requiring transfusion, length of intensive care unit (ICU) stay, neurologic outcome (Cerebral Performance Category [CPC] score 1-2=good; 3-5=poor), time from arrest to initiation of TH protocol and in-hospital death.
Results: MCS was used in 61/336 (18%) pts; 43/61 (71%) were men. Devices included: intra-aortic balloon pump (53 pts; 87%); Impella (3 pts; 5%); Tandem Heart (2 pts; 3%); and extracorporeal membrane oxygenation (14 pts; 23%). Univariate analysis revealed that significant bleeding was more common (25% vs. 8%, p<0.001), intracranial bleeding was similar (3% vs. 1%, p=NS), and length of ICU stay was longer in MCS group (7.1 ± 9.7 vs. 5.4 ± 4.3 days, p <0.05). There was no difference in CPC ≤ 2 at discharge (30% vs. 39%, p=NS), time to initiation of TH (170.4 ± 147.5 vs. 188.7 ± 137.9 minutes, p=NS) or death (66% vs. 56%, p=NS) in pts treated with MCS. After propensity score weighting, use of MCS was associated with higher incidence of significant bleeding, lower frequency of CPC ≤ 2 at discharge, and higher likelihood of longer ICU stay (Table).
Conclusions: Use of MCS in conjunction with TH is associated with a higher risk of significant bleeding and higher likelihood of longer ICU stay but a lower likelihood of good neurologic outcome (CPC ≤ 2) at discharge. MCS use was not associated with a delay in initiation of TH protocol or a higher risk of death. Future prospective studies assessing the efficacy of MCS in TH are needed.
Author Disclosures: N. Bhatia: None. A. Nayeri: None. B. Holmes: None. W. Armstrong: None. N. Borges: None. M. Young: None. S. Huang: None. J. McPherson: None.
- © 2016 by American Heart Association, Inc.