Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5

Early Impella support in post-cardiac arrest cardiogenic shock complicating acute myocardial infarction improves short and long term survival
G. Chatzis1, S. Syntila1, B. Markus2, H. Ahrens1, D. Divchev1, U. Lüsebrink1, K. Karatolios1, B. Schieffer2
1Klinik für Innere Medizin - Schwerpunkt Kardiologie, Universitätsklinikum Giessen und Marburg GmbH, Marburg; 2Klinik für Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum Giessen und Marburg GmbH, Marburg;

Objective

Early mechanical circulatory support with Impella may improve survival outcomes in the setting of post-cardiac arrest cardiogenic shock (CS) after out of hospital cardiac arrest (OHCA) complicating acute myocardial infarction (AMI). However, the optimal timing to initiate mechanical circulatory support (MCS) in this particular setting remains unclear. Therefore, we aimed to compare survival outcomes of patients supported with Impella 2.5 before percutaneous coronary intervention (PCI) (pre-PCI) to those supported after PCI (post-PCI).

Design

Retrospective single center study between September 2014 and December 2019 admitted to Cardiac Arrest Center in Marburg, Germany.

Patients

Out of 2105 patients resuscitated from OHCA due to AMI with post-cardiac arrest CS between September 2014 and December 2019 and admitted to our regional cardiac arrest center, 81 consecutive patients receiving Impella 2.5 during admission coronary angiogram were identified.

Outcomes/Measurements

Survival outcomes were compared between those with Impella support before to those with support after PCI.

Main Results

A total of 81 consecutive patients with infarct-related post-cardiac arrest shock supported with Impella 2.5 during admission coronary angiogram were included. All patients were in profound CS requiring catecholamines on admission. Overall survival to discharge and at 6-months was 40.7% and 38.3%, respectively. Patients in the pre-PCI group had a higher survival to discharge and at 6-months as compared to patients of the post-PCI group (54.3% versus 30.4%, p=0.04 and 51.4% versus 28.2%, p=0.04, respectively). Moreover, the patients in the early support group demonstrated a greater functional recovery of the left ventricle and a better restoration of the end-organ function when Impella support was initiated prior to PCI.

Conclusions

Our results suggest that the early initiation of MCS with Impella 2.5 prior to PCI is associated with improved hospital and 6-month survival in patients with post-cardiac arrest CS complicating AMI.


https://dgk.org/kongress_programme/jt2022/aP1216.html