Abstract 17670: Mechanical Circulatory Support for Cardiovascular Shock: Results From the Japanese Circulation Society Cardiovascular Shock Registry
Introduction: Mechanical circulatory support (MCS) such as intra-aortic balloon pump (IABP) and extracorporeal membrane oxygenation (ECMO) are widely used for patients with profound or refractory cardiovascular shock. However, little is known about outcome of cardiovascular shock patients undergoing MCS.
Methods: A total of 979 patients with cardiovascular shock were enrolled from the Japanese Circulation Society Cardiovascular Shock registry, which is a prospective, observational, multi-center, cohort study conducted from May 2012 to June 2014. Of those, 704 patients who had not experienced out-of-hospital cardiac arrest, including 160 patients undergoing IABP (IABP group), 17 undergoing ECMO (ECMO group), 61 undergoing ECMO and IABP (ECMO+IABP group), and 466 not undergoing MCS (non-MCS group), were included in this study. The primary endpoint was all-cause mortality at 30 days.
Results: The systolic blood pressure on hospital arrival was significantly different among four groups (79.2±15.5 mmHg in the non-MCS group, 77.5±15.0 mmHg in the IABP group, 69.8±17.6 mmHg in the ECMO group, 74.5±13.6 mmHg in the ECMO+IABP group, p=0.029). The 30-day mortality was higher in both ECMO groups than other groups (20.0 % in the non-MCS group, 27.5% in the IABP group, 58.8% in the ECMO group, 60.7% in the ECMO+IABP group, p<0.001). After adjusting confounders, the use of IABP was not an independent predictor of 30-day mortality, whereas the use of ECMO or ECMO+IABP were independently associated with 30-day mortality (reference: no use of MCS) (adjusted odds ratio [95% CI]: 1.60 [0.97-2.62], p=0.063 in the IABP group, 8.46 [2.59-27.58], p<0.001 in the ECMO group, 8.53 [4.20-17.31], p<0.001 in the ECMO+IABP group).
Conclusions: Although there was insufficient evidence to support or refute the use of MCS in patients with cardiovascular shock, the use of IABP did not significantly reduce 30-day mortality. Furthermore, the use of ECMO had poor outcome despite the use of IABP.
Author Disclosures: Y. Ueki: None. H. Imamura: None. T. Miyamoto: None. T. Yagi: None. K. Sakamoto: None. H. Takahashi: None. H. Hanada: None. N. Yonemoto: None. E. Tachibana: None. K. Nagao: None.
- © 2016 by American Heart Association, Inc.