Morbidität und Mortalität bei Patient:innen im kardiogenen Schock unter Therapie der linksventrikulären Mikroaxialpumpe Impella®
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Philipps-Universität Marburg
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Abstract
Despite advancements in therapy cardiogenic shock remains associated with a
high mortality. In order to achieve left ventricular unloading, temporary
mechanical circulatory support systems such as the Impella® microaxial pump
have been developed, especially considering the previously widely used IABP
failed to demonstrate improvements in hemodynamics and mortality in
cardiogenic shock. The objective of this study was to evaluate the effectiveness,
handling and safety of Impella® in patients in cardiogenic shock. Different groups
that could benefit from the microaxial pump were to be analyzed in terms of
morbidity and mortality.
Retrospective data from 112 patients in cardiogenic shock with Impella® from
January 2013 to July 2015 in two centers were analyzed. The effectiveness of the
microaxial pump was assessed based on the required catecholamine therapy,
lactate levels and other laboratory parameters for organ function evaluation as
well as intensive care scores. Additionally, Impella®-associated complications
were analyzed and intrahospital and 30-day mortality were determined in different
groups.
The investigated cohort had a median age of 73.0 years (61.0-79.0 years). Basic
characteristics were comparable between resuscitated and non-resuscitated
patients (CPR+Schock vs. Schock) and in subgroups (Impella® 2.5 vs. CP, male
(m) vs. female (f), < vs. ≥ 75 years). The most common cause of cardiogenic
shock was acute myocardial infarction at 85.7% (43.8% STEMI, 42.0%
NSTEMI). 86.6% had relevant coronary artery disease, with the majority (53.6%)
having three-vessel CAD.
Overall, a trend towards reduction in dobutamine therapy within the first 72 hours
after Impella® implantation was observed (Implantation 333.3 μg/min (0-416.7
μg/min), 72h 250.0 μg/min (0-416.7 μg/min) [p=0.07]), significantly for women
[p=0.02]. Additionally, a significant decrease in lactate levels with Impella® was
observed (Implantation 2.5 mmol/l (1.0-6.25 mmol/l), 72h 1.0 mmol/l (1.0-2.0
mmol/l) [p=0.0002]).
Compared to non-resuscitated patients (CPR+Schock vs. Schock), resuscitated
patients showed at Impella® implantation an increased need for noradrenaline and
adrenaline [p=0.05/p=0.001], CardShock risk Score [p=0.02] and a tendency
towards increased lactate levels [p=0.08] and liver failure [p=0.15]. Mechanical
ventilation [p<0.0001] and suspected hypoxic brain injury [p=0.0014] were
significantly more frequent. Patients with Impella® CP tended to have higher
noradrenaline doses (2.5 vs. CP p=0.13) and CardShock risk scores (2.5 vs. CP
p=0.08) at implantation. Female patients also initially had a high noradrenaline
requirement (m vs. f p=0.01).
The handling of Impella® was uncomplicated regarding implantation,
repositioning, and technical management. Impella®-associated bleeding at
puncture site was rare (8.0%), but more frequent with Impella® CP (2.5 vs. CP
p=0.03). Multifactorial bleeding required red blood cell transfusion especially in
female patients (m vs. f p=0.03) and during Impella® CP treatment (2.5 vs. CP
p=0.006).
The overall intrahospital mortality with Impella® support was 58.9%. This was
significantly higher for resuscitated patients (CPR+Schock vs. Schock 70.4% vs.
48.3% [p=0.02]). Even after 30 days, survival was better for patients without
resuscitation (51.7% vs. 31.5% [p=0.009]). No difference in intrahospital and 30-
day mortality was observed between Impella® models and within other
subgroups.
In conclusion, this study demonstrated the Impella® microaxial pump as a safe
and easily manageable circulatory support system for patients in cardiogenic
shock. Regarding effectiveness, the data suggested clinically relevant
improvement in hemodynamics during Impella® treatment. Despite different
ejection capabilities, no significant differences were observed between the two
Impella® models. However, evaluating the clinical effect is complicated by the
inherently high mortality of cardiogenic shock, especially in resuscitated patients.
Therefore, randomized, controlled trials are needed to determine which patient
group benefits from Impella® at which point in time and to what extent it
positively influences the outcome of cardiogenic shock.
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Dates
Created: 2024Issued: 2025-02-12Updated: 2025-02-12
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
DDC-Numbers
610
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Ensel, Juliane: Morbidität und Mortalität bei Patient:innen im kardiogenen Schock unter Therapie der linksventrikulären Mikroaxialpumpe Impella®. : Philipps-Universität Marburg 2025-02-12. DOI: https://doi.org/10.17192/z2025.0032.
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This item has been published with the following license: In Copyright