Abstract 20138: What is a Realistically Low Mortality in Cardiogenic Shock?
Background: In geographic areas with abundant revascularization options, both the incidence and mortality of cardiogenic shock (CS) seem to be decreasing. However, an aggressive revascularization strategy for ischemic heart disease seems to bring acute CS-mortality only to a sub 40% level and therefore a need for improvement still exists. We have established a “cardiogenic shock-team” with the intent to institute ECMO-treatment early in patients deemed insufficiently supported with medical treatment and acute revascularization.
Methods: We evaluated 1497 patients diagnosed with cardiac failure admitted to the University Hospital of Northern Norway 2013 and 2014, after the systematic ECMO-algorithm was established, to find cases of cardiogenic shock and postcardiotomia heart failure. These patients were compared to an earlier study in our institution during the years 2003 and 2004.
Results: Our pre-ECMO results demonstrated a 30 day mortality of 38% in 126 patients with cardiogenic shock and postcardiotomia heartfailure treated in a 2 year periode. Twelve % (n=15) of the diseased patients were deemed to be potential candidates for ECMO-treatment.
In the two year period since establishing the ECMO-team model we treated 73 patients using identical criteria for CS. 12 patients (16%) were treated with ECMO. CS hospital mortality during the last period was 28%, . Among the nonsurvivors ECMO was declined because of age in 32%, preexisting co morbidity in 9%, uncontrolled bleeding in 5% and multi organ failure in 27%. Hospital mortality among the ECMO patients was 25% and 30-day mortality was 33%. Kaplan-Meier curves comparing ECMO vs non ECMO patients show no difference in long term survival.
We identified 5 nonsurviving non-ECMO patients who potentially could have been selected for ECMO-treatment by our contemporary ECMO-protocol.
Conclusion: Establishing a cardiogenic shock-team has improved the survival of these patients. Our retrospective analysis indicates that the triage of these patients can be even more refined. However, given some of these patients age and comorbidity, a close to zero mortality does not seem clinically realistic.
Author Disclosures: T.O. Naesheim: None. K. Hansen: None. A. Blakar: None. T. Myrmel: None.
- © 2016 by American Heart Association, Inc.