Badiye Amit P, Hernandez Gabriel A, Novoa Italo, Chaparro Sandra V
From the *Division of Cardiology and †Department of Medicine, University of Miami, Jackson Memorial Hospital, Miami, Florida.
ASAIO J. 2016 Jan-Feb;62(1):11-4. doi: 10.1097/MAT.0000000000000290.
Impella assist devices have been increasingly used in cardiogenic shock (CS). This study aims to assess the incidence of hemolysis when Impella support is used longer than 6 hours in CS. We retrospectively studied all patients who required Impella between April 2009 and September 2013. Demographic data and hemolysis indicators were sampled and analyzed using paired t-test. A total of 118 devices were placed and 40 used longer than 6 hours. The average time of support was 86.63 hours, and the 30 and 90 days of survival were 65% and 60%, respectively. After 24 hours of support, the hemoglobin (Hb) decreased significantly despite 17% of patients receiving blood transfusion (p = 0.0001). By the time of removal, 65% of patients were transfused to maintain a Hb of 10 mg/dl (p = 0.0014). The lactate dehydrogenase (LDH) increased to 5,201 U/L (n = 22; p = 0.0096), the bilirubin to 5.6 mg/dl (p = 0.008), and the haptoglobin level was 15.4 mg/dl (n = 25). The cumulative incidence of hemolysis was 62.5%. Hemolysis is a common occurrence in patients with long-term Impella support for CS, evaluated by the persistent decline in Hb and haptoglobin as well as increase in LDH and bilirubin. Strict monitoring of hemolysis parameters at baseline and at frequent intervals is crucial.
Impella辅助装置在心源性休克（CS）中的应用日益广泛。本研究旨在评估在CS中使用Impella支持超过6小时时溶血的发生率。我们回顾性研究了2009年4月至2013年9月期间所有需要使用Impella的患者。收集人口统计学数据和溶血指标，并采用配对t检验进行分析。共植入118个装置，其中40个使用时间超过6小时。平均支持时间为86.63小时，30天和90天生存率分别为65%和60%。支持24小时后，尽管17%的患者接受了输血，但血红蛋白（Hb）仍显著下降（p = 0.0001）。到移除装置时，65%的患者接受了输血以维持Hb水平在10 mg/dl（p = 0.0014）。乳酸脱氢酶（LDH）升至5201 U/L（n = 22；p = 0.0096），胆红素升至5.6 mg/dl（p = 0.008），触珠蛋白水平为15.4 mg/dl（n = 25）。溶血的累积发生率为62.5%。通过Hb和触珠蛋白持续下降以及LDH和胆红素升高评估，溶血在长期使用Impella支持的CS患者中很常见。在基线和频繁间隔时严格监测溶血参数至关重要。
