Chatzis Georgios, Syntila Styliani, Markus Birgit, Ahrens Holger, Patsalis Nikolaos, Luesebrink Ulrich, Divchev Dimitar, Parahuleva Mariana, Al Eryani Hanna, Schieffer Bernhard, Karatolios Konstantinos
Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, 35037 Marburg, Germany.
J Clin Med. 2021 Feb 13;10(4):747. doi: 10.3390/jcm10040747.
Since mechanical circulatory support (MCS) devices have become integral component in the therapy of refractory cardiogenic shock (RCS), we identified 67 patients in biventricular support with Impella and venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO) for RCS between February 2013 and December 2019 and evaluated the risk factors of mortality in this setting. Mean age was 61.07 ± 10.7 and 54 (80.6%) patients were male. Main cause of RCS was acute myocardial infarction (AMI) (74.6%), while 44 (65.7%) were resuscitated prior to admission. The mean Simplified Acute Physiology Score II (SAPS II) and Sequential Organ Failure Assessment Score (SOFA) score on admission was 73.54 ± 16.03 and 12.25 ± 2.71, respectively, corresponding to an expected mortality of higher than 80%. Vasopressor doses and lactate levels were significantly decreased within 72 h on biventricular support ( < 0.05 for both). Overall, 17 (25.4%) patients were discharged to cardiac rehabilitation and 5 patients (7.5%) were bridged successfully to ventricular assist device implantation, leading to a total of 32.8% survival on hospital discharge. The 6-month survival was 31.3%. Lactate > 6 mmol/L, vasoactive score > 100 and pH < 7.26 on initiation of biventricular support, as well as Charlson comorbity index > 3 and prior resuscitation were independent predictors of survival. In conclusion, biventricular support with Impella and VA-ECMO in patients with RCS is feasible and efficient leading to a better survival than predicted through traditional risk scores, mainly via significant hemodynamic improvement and reduction in lactate levels.
由于机械循环支持（MCS）设备已成为难治性心源性休克（RCS）治疗中不可或缺的组成部分，我们确定了2013年2月至2019年12月期间67例使用Impella和静脉-动脉体外膜肺氧合（VA-ECMO）进行双心室支持治疗RCS的患者，并评估了这种情况下的死亡风险因素。平均年龄为61.07±10.7岁，54例（80.6%）患者为男性。RCS的主要病因是急性心肌梗死（AMI）（74.6%），而44例（65.7%）患者在入院前已接受复苏。入院时简化急性生理学评分II（SAPS II）和序贯器官衰竭评估评分（SOFA）的平均值分别为73.54±16.03和12.25±2.71，对应的预期死亡率高于80%。双心室支持72小时内血管活性药物剂量和乳酸水平显著降低（两者均P<0.05）。总体而言，17例（25.4%）患者出院后接受心脏康复治疗，5例（7.5%）患者成功过渡到心室辅助装置植入，出院时总生存率为32.8%。6个月生存率为31.3%。双心室支持开始时乳酸>6 mmol/L、血管活性评分>100、pH<7.26，以及Charlson合并症指数>3和既往复苏是生存的独立预测因素。总之，对于RCS患者，使用Impella和VA-ECMO进行双心室支持是可行且有效的，主要通过显著改善血流动力学和降低乳酸水平，其生存率高于传统风险评分预测的结果。
