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Billig S, Zayat R, Yelenski S, Nix C, Bennek-Schoepping E, Hochhausen N, Derwall M. The Self-Expandable Impella CP (ECP) as a Mechanical Resuscitation Device. Bioengineering (Basel) 2024; 11:456. [PMID: 38790323 PMCID: PMC11118512 DOI: 10.3390/bioengineering11050456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/23/2024] [Accepted: 04/30/2024] [Indexed: 05/26/2024] Open
Abstract
The survival rate of cardiac arrest (CA) can be improved by utilizing percutaneous left ventricular assist devices (pLVADs) instead of conventional chest compressions. However, existing pLVADs require complex fluoroscopy-guided placement along a guidewire and suffer from limited blood flow due to their cross-sectional area. The recently developed self-expandable Impella CP (ECP) pLVAD addresses these limitations by enabling guidewire-free placement and increasing the pump cross-sectional area. This study evaluates the feasibility of resuscitation using the Impella ECP in a swine CA model. Eleven anesthetized pigs (73.8 ± 1.7 kg) underwent electrically induced CA, were left untreated for 5 min and then received pLVAD insertion and activation. Vasopressors were administered and defibrillations were attempted. Five hours after the return of spontaneous circulation (ROSC), the pLVAD was removed, and animals were monitored for an additional hour. Hemodynamics were assessed and myocardial function was evaluated using echocardiography. Successful guidewire-free pLVAD placement was achieved in all animals. Resuscitation was successful in 75% of cases, with 3.5 ± 2.0 defibrillations and 1.8 ± 0.4 mg norepinephrine used per ROSC. Hemodynamics remained stable post-device removal, with no adverse effects or aortic valve damage observed. The Impella ECP facilitated rapid guidewire-free pLVAD placement in fibrillating hearts, enabling successful resuscitation. These findings support a broader clinical adoption of pLVADs, particularly the Impella ECP, for CA.
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Affiliation(s)
- Sebastian Billig
- Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Rachad Zayat
- Department of Cardiothoracic Surgery, Heart Center Trier, Barmherzigen Brüder Hospital Trier, 54292 Trier, Germany
| | - Siarhei Yelenski
- Department of Thoracic Surgery, Medical Faculty RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany
| | | | | | - Nadine Hochhausen
- Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Matthias Derwall
- Department of Anesthesia, Critical Care and Pain Medicine, St. Johannes Hospital, 44137 Dortmund, Germany
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2
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Gottula AL, McCracken BM, Nakashima T, Greer NL, Cramer TA, Sutton NR, Ward KR, Neumar RW, Hakam Tiba M, Hsu CH. Percutaneous left ventricular assist devices in refractory cardiac arrest: The role of chest compressions. Resusc Plus 2023; 16:100488. [PMID: 38143529 PMCID: PMC10746849 DOI: 10.1016/j.resplu.2023.100488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/22/2023] [Accepted: 09/30/2023] [Indexed: 12/26/2023] Open
Abstract
Background Recent studies describe an emerging role for percutaneous left ventricular assist devices such as Impella CP® as rescue therapy for refractory cardiac arrest. We hypothesized that the addition of mechanical chest compressions to percutaneous left ventricular assist device assisted CPR would improve hemodynamics by compressing the right ventricle and augmenting pulmonary blood flow and left ventricular filling. We performed a pilot study to test this hypothesis using a swine model of prolonged cardiac arrest. Methods Eight Yorkshire swine were anesthetized, intubated, and instrumented for hemodynamic monitoring. They were subjected to untreated ventricular fibrillation for 5.75 (SD 2.90) minutes followed by mechanical chest compressions for a mean of 20.0 (SD 5.0) minutes before initiation of percutaneous left ventricular assist device. After percutaneous left ventricular assist device initiation, mechanical chest compressions was stopped (n = 4) or continued (n = 4). Defibrillation was attempted 4, 8 and 12 minutes after initiating percutaneous left ventricular assist device circulatory support. Results The percutaneous left ventricular assist device + mechanical chest compressions group had significantly higher percutaneous left ventricular assist device flow prior to return of spontaneous heartbeat at four- and twelve-minutes after percutaneous left ventricular assist device initiation, and significantly higher end tidal CO2 at 4-minutes after percutaneous left ventricular assist device initiation, when compared with the percutaneous left ventricular assist device alone group. Carotid artery flow was not significantly different between the two groups. Conclusion The addition of mechanical chest compressions to percutaneous left ventricular assist device support during cardiac arrest may generate higher percutaneous left ventricular assist device and carotid artery flow prior to return of spontaneous heartbeat compared to percutaneous left ventricular assist device alone. Further studies are needed to determine if this approach improves other hemodynamic parameters or outcomes after prolonged cardiac arrest.
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Affiliation(s)
- Adam L. Gottula
- Department of Emergency Medicine and Anesthesiology, The Harry Max Weil Institute for Critical Care Research and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, United States
| | - Brendan M. McCracken
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, United States
| | - Takahiro Nakashima
- Department of Emergency Medicine, The Harry Max Weil Institute for Critical Care Research and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, United States
| | - Nicholas L. Greer
- Department of Emergency Medicine, The Harry Max Weil Institute for Critical Care Research and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, United States
| | - Traci A. Cramer
- Department of Emergency Medicine, The Harry Max Weil Institute for Critical Care Research and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, United States
| | - Nadia R. Sutton
- Department of Internal Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, United States
| | - Kevin R. Ward
- Department of Emergency Medicine, The Harry Max Weil Institute for Critical Care Research and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, United States
| | - Robert W. Neumar
- Department of Emergency Medicine, The Harry Max Weil Institute for Critical Care Research and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, United States
| | - Mohamad Hakam Tiba
- Department of Emergency Medicine, The Harry Max Weil Institute for Critical Care Research and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, United States
| | - Cindy H. Hsu
- Department of Emergency Medicine, The Harry Max Weil Institute for Critical Care Research and Innovation, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI 48109, United States
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Ardito V, Sarucanian L, Rognoni C, Pieri M, Scandroglio AM, Tarricone R. Impella Versus VA-ECMO for Patients with Cardiogenic Shock: Comprehensive Systematic Literature Review and Meta-Analyses. J Cardiovasc Dev Dis 2023; 10:jcdd10040158. [PMID: 37103037 PMCID: PMC10142129 DOI: 10.3390/jcdd10040158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/27/2023] [Accepted: 03/27/2023] [Indexed: 04/28/2023] Open
Abstract
Impella and VA-ECMO are two possible therapeutic courses for the treatment of patients with cardiogenic shock (CS). The study aims to perform a systematic literature review and meta-analyses of a comprehensive set of clinical and socio-economic outcomes observed when using Impella or VA-ECMO with patients under CS. A systematic literature review was performed in Medline, and Web of Science databases on 21 February 2022. Nonoverlapping studies with adult patients supported for CS with Impella or VA-ECMO were searched. Study designs including RCTs, observational studies, and economic evaluations were considered. Data on patient characteristics, type of support, and outcomes were extracted. Additionally, meta-analyses were performed on the most relevant and recurring outcomes, and results shown using forest plots. A total of 102 studies were included, 57% on Impella, 43% on VA-ECMO. The most common outcomes investigated were mortality/survival, duration of support, and bleeding. Ischemic stroke was lower in patients treated with Impella compared to the VA-ECMO population, with statistically significant difference. Socio-economic outcomes including quality of life or resource use were not reported in any study. The study highlighted areas where further data collection is needed to clarify the value of complex, new technologies in the treatment of CS that will enable comparative assessments focusing both on the health impact on patient outcomes and on the financial burden for government budgets. Future studies need to fill the gap to comply with recent regulatory updates at the European and national levels.
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Affiliation(s)
- Vittoria Ardito
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, 20136 Milan, Italy
| | - Lilit Sarucanian
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, 20136 Milan, Italy
| | - Carla Rognoni
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, 20136 Milan, Italy
| | - Marina Pieri
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Anna Mara Scandroglio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Rosanna Tarricone
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, 20136 Milan, Italy
- Department of Social and Political Science, Bocconi University, 20136 Milan, Italy
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Harhash AA, Kern KB. Cardiac arrest in the catheterization laboratory: Are we getting better at resuscitation? Resuscitation 2022; 180:8-10. [PMID: 36058319 DOI: 10.1016/j.resuscitation.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Ahmed A Harhash
- University of Vermont Medical Center, Burlington, VT, United States
| | - Karl B Kern
- University of Arizona Sarver Heart Center, Tucson, AZ, United States.
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Tan SR, Low CJW, Ng WL, Ling RR, Tan CS, Lim SL, Cherian R, Lin W, Shekar K, Mitra S, MacLaren G, Ramanathan K. Microaxial Left Ventricular Assist Device in Cardiogenic Shock: A Systematic Review and Meta-Analysis. Life (Basel) 2022; 12:life12101629. [PMID: 36295065 PMCID: PMC9605512 DOI: 10.3390/life12101629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/11/2022] [Accepted: 10/14/2022] [Indexed: 11/29/2022] Open
Abstract
Microaxial left ventricular assist devices (LVAD) are increasingly used to support patients with cardiogenic shock; however, outcome results are limited to single-center studies, registry data and select reviews. We conducted a systematic review and meta-analysis, searching three databases for relevant studies reporting on microaxial LVAD use in adults with cardiogenic shock. We conducted a random-effects meta-analysis (DerSimonian and Laird) based on short-term mortality (primary outcome), long-term mortality and device complications (secondary outcomes). We assessed the risk of bias and certainty of evidence using the Joanna Briggs Institute and the GRADE approaches, respectively. A total of 63 observational studies (3896 patients), 6 propensity-score matched (PSM) studies and 2 randomized controlled trials (RCTs) were included (384 patients). The pooled short-term mortality from observational studies was 46.5% (95%-CI: 42.7–50.3%); this was 48.9% (95%-CI: 43.8–54.1%) amongst PSM studies and RCTs. The pooled mortality at 90 days, 6 months and 1 year was 41.8%, 51.1% and 54.3%, respectively. Hemolysis and access-site bleeding were the most common complications, each with a pooled incidence of around 20%. The reported mortality rate of microaxial LVADs was not significantly lower than extracorporeal membrane oxygenation (ECMO) or intra-aortic balloon pumps (IABP). Current evidence does not suggest any mortality benefit when compared to ECMO or IABP.
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Affiliation(s)
- Shien Ru Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Christopher Jer Wei Low
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Wei Lin Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Ryan Ruiyang Ling
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 119228, Singapore
| | - Shir Lynn Lim
- Department of Cardiology, National University Heart Centre, Singapore 119228, Singapore
| | - Robin Cherian
- Department of Cardiology, National University Heart Centre, Singapore 119228, Singapore
| | - Weiqin Lin
- Department of Cardiology, National University Heart Centre, Singapore 119228, Singapore
| | - Kiran Shekar
- Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, QLD 4032, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD 4000, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD 4072, Australia
- Faculty of Medicine, Bond University, Gold Coast, QLD 4226, Australia
| | - Saikat Mitra
- Intensive Care Unit, Dandenong and Casey Hospital, Monash Health, Melbourne, VIC 3175, Australia
| | - Graeme MacLaren
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Health System, Singapore 119228, Singapore
| | - Kollengode Ramanathan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Health System, Singapore 119228, Singapore
- Correspondence:
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Mørk SR, Bøtker MT, Christensen S, Tang M, Terkelsen CJ. Survival and neurological outcome after out-of-hospital cardiac arrest treated with and without mechanical circulatory support. Resusc Plus 2022; 10:100230. [PMID: 35434669 PMCID: PMC9010695 DOI: 10.1016/j.resplu.2022.100230] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/09/2022] [Accepted: 03/18/2022] [Indexed: 11/18/2022] Open
Abstract
Aim The aim of this study was to describe the survival and neurological outcome in patients with OHCA treated with and without mechanical circulatory support (MCS). Methods This was a retrospective observational cohort study on patients with OHCA admitted to Aarhus University Hospital, Denmark, between January 2015 and December 2019. Kaplan-Meier estimates were used to evaluate 30-day and 30–180-day survival. Cox regression analysis was used to assess the association between covariates and one-year mortality. Results Among 1,015 patients admitted, 698 achieved return of spontaneous circulation (ROSC) before admission, 101 patients with refractory OHCA received mechanical circulatory support (MCS) and the remaining 216 patients with refractory OHCA did not receive MCS treatment. Survival to hospital discharge was 47% (478/1015). Good neurological outcome defined as Cerebral Performance Categories 1–2 were seen among 92% (438/478) of the patients discharged from hospital. Median low-flow was 15 [8–22] minutes in the ROSC group and 105 [94–123] minutes in the MCS group. Mortality rates were high within the first 30 days, however; 30–180-day survival in patients discharged remained constant over time in both patients with ROSC on admission and patients admitted with MCS. Advanced age > 70 years (hazard ratio (HR) 1.98, 95% confidence interval (CI) 1.11–3.49), pulseless electrical activity (HR 2.39, 95% CI 1.25–4.60) and asystole HR 2.70, 95% CI 1.25–5.95) as initial rhythms were associated with one-year mortality in patients with ROSC. Conclusions Short-term survival rates were high among patients with ROSC and patients receiving MCS. Among patients who survived to day 30, landmark analyses showed comparable 180-day survival in the two groups despite long low-flow times in the MCS group. Advanced age and initial non-shockable rhythms were independent predictors of one-year mortality in patients with ROSC on admission.
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Affiliation(s)
- Sivagowry Rasalingam Mørk
- Department of Cardiology, Aarhus University Hospital, Denmark
- Aarhus University, Aarhus, Denmark
- Corresponding author at: Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark.
| | - Morten Thingemann Bøtker
- Aarhus University, Aarhus, Denmark
- Research and Development, Prehospital Emergency Medical Services, Central Denmark Region, Denmark
| | - Steffen Christensen
- Aarhus University, Aarhus, Denmark
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Denmark
| | - Mariann Tang
- Aarhus University, Aarhus, Denmark
- Department of Thoracic and Vascular Surgery, Aarhus University Hospital, Denmark
| | - Christian Juhl Terkelsen
- Department of Cardiology, Aarhus University Hospital, Denmark
- Aarhus University, Aarhus, Denmark
- The Danish Heart Foundation, Denmark
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7
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Dunning J, Archbold A, de Bono JP, Butterfield L, Curzen N, Deakin CD, Gudde E, Keeble TR, Keys A, Lewis M, O'Keeffe N, Sarma J, Stout M, Swindell P, Ray S. Joint British Societies' guideline on management of cardiac arrest in the cardiac catheter laboratory. BRITISH HEART JOURNAL 2022; 108:e3. [PMID: 35470236 DOI: 10.1136/heartjnl-2021-320588] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
More than 300 000 procedures are performed in cardiac catheter laboratories in the UK each year. The variety and complexity of percutaneous cardiovascular procedures have both increased substantially since the early days of invasive cardiology, when it was largely focused on elective coronary angiography and single chamber (right ventricular) permanent pacemaker implantation. Modern-day invasive cardiology encompasses primary percutaneous coronary intervention, cardiac resynchronisation therapy, complex arrhythmia ablation and structural heart interventions. These procedures all carry the risk of cardiac arrest.We have developed evidence-based guidelines for the management of cardiac arrest in adult patients in the catheter laboratory. The guidelines include recommendations which were developed by collaboration between nine professional and patient societies that are involved in promoting high-quality care for patients with cardiovascular conditions. We present a set of protocols which use the skills of the whole catheter laboratory team and which are aimed at achieving the best possible outcomes for patients who suffer a cardiac arrest in this setting. We identified six roles and developed a treatment algorithm which should be adopted during cardiac arrest in the catheter laboratory. We recommend that all catheter laboratory staff undergo regular training for these emergency situations which they will inevitably face.
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Affiliation(s)
- Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, Middlesbrough, UK
| | - Andrew Archbold
- Department of General & Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Joseph Paul de Bono
- Department of Cardiology, Queen Elizabeth Hospital, University of Birmingham, Birmingham, West Midlands, UK
| | - Liz Butterfield
- School of Nursing, Midwifery and Social Work, Faculty of Health and Wellbeing, Canterbury Christ Church University, Canterbury, UK
| | - Nick Curzen
- Faculty of Medicine, University of Southampton and Department of Cardiology, Southampton, UK
| | - Charles D Deakin
- Anaesthesia and Intensive Care, Southampton University Hospitals NHS Trust, Southampton, Southampton, UK
| | - Ellie Gudde
- Essex Cardiothoracic Centre, Mid and South Essex NHS Trust, Basildon, Essex, UK.,Medical Technology Research Centre, Anglia Ruskin School of Medicine, Chelmsford, UK
| | - Thomas R Keeble
- Essex Cardiothoracic Centre, Mid and South Essex NHS Trust, Basildon, Essex, UK.,Medical Technology Research Centre, Anglia Ruskin School of Medicine, Chelmsford, UK
| | - Alan Keys
- Cardiovascular Care Partnership (UK), British Cardiovascular Society, London, London, UK
| | - Mike Lewis
- Department of Cardiac Surgery, Royal Sussex County Hospital, Brighton, UK
| | - Niall O'Keeffe
- Department of Cardiothoracic Anaesthesia and Critical Care, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Jaydeep Sarma
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Martin Stout
- School of Healthcare Science, Manchester Metropolitan University, Manchester, UK
| | | | - Simon Ray
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
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Delmas C, Pernot M, Le Guyader A, Joret R, Roze S, Lebreton G. Budget Impact Analysis of Impella CP ® Utilization in the Management of Cardiogenic Shock in France: A Health Economic Analysis. Adv Ther 2022; 39:1293-1309. [PMID: 35067868 PMCID: PMC8918169 DOI: 10.1007/s12325-022-02040-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/05/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Early detection and treatment of cardiogenic shock (CS) is crucial to avoid irreparable multiorgan damage and mortality. Impella CP® is a novel temporary mechanical circulatory support (MCS) device associated with greater hemodynamic support and significantly fewer device-related complications compared with other MCS devices, e.g., intra-aortic balloon pumps (IABP) and venoarterial extracorporeal membrane oxygenation (VA-ECMO). The present study evaluated the budget impact of introducing Impella CP versus IABP and VA-ECMO in patients with CS following an acute myocardial infarction (MI) in France. METHODS A budget impact model was developed to compare the cost of introducing Impella CP with continuing IABP and VA-ECMO treatment from a Mandatory Health Insurance (MHI) perspective in France over a 5-year time horizon, with 700 patients with refractory CS assumed to be eligible for treatment per year. Costs associated with Impella CP and device-related complications for all interventions were captured and clinical input data were based on published sources. Scenario analyses were performed around key parameters. RESULTS Introducing Impella CP was associated with cumulative cost savings of EUR 2.7 million over 5 years, versus continuing current clinical practice with IABP and VA-ECMO. Cost savings were achieved in every year of the analysis and driven by the lower incidence of device-related complications with Impella CP, with estimated 5-year cost savings of EUR 22.4 million due to avoidance of complications. Total cost savings of more than EUR 250,000 were projected in the first year of the analysis, which increased as the market share of Impella CP was increased. Scenario analyses indicated that the findings of the analysis were robust. CONCLUSION Treatment with Impella CP in adult patients aged less than 75 years in a state of refractory CS following an MI was projected to lead to substantial cost savings from an MHI perspective in France, compared with continuing current clinical practice.
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Affiliation(s)
- Clément Delmas
- Intensive Cardiac Care Unit, Cardiology Department, Rangueil University Hospital, Toulouse, France
| | - Mathieu Pernot
- Department of Cardiology and Cardiovascular Surgery, Haut-Lévèque University Hospital, Bordeaux, France
| | - Alexandre Le Guyader
- Department of Thoracic and Cardiovascular Surgery, Dupuytren University Hospital, Limoges, France
| | | | | | - Guillaume Lebreton
- Cardiac Surgery Department, Pitié-Salpétrière Hospital, Sorbonne University, Paris, France
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Lott C, Truhlář A, Alfonzo A, Barelli A, González-Salvado V, Hinkelbein J, Nolan JP, Paal P, Perkins GD, Thies KC, Yeung J, Zideman DA, Soar J. [Cardiac arrest under special circumstances]. Notf Rett Med 2021; 24:447-523. [PMID: 34127910 PMCID: PMC8190767 DOI: 10.1007/s10049-021-00891-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 01/10/2023]
Abstract
These guidelines of the European Resuscitation Council (ERC) Cardiac Arrest under Special Circumstances are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the modifications required for basic and advanced life support for the prevention and treatment of cardiac arrest under special circumstances; in particular, specific causes (hypoxia, trauma, anaphylaxis, sepsis, hypo-/hyperkalaemia and other electrolyte disorders, hypothermia, avalanche, hyperthermia and malignant hyperthermia, pulmonary embolism, coronary thrombosis, cardiac tamponade, tension pneumothorax, toxic agents), specific settings (operating room, cardiac surgery, cardiac catheterization laboratory, dialysis unit, dental clinics, transportation [in-flight, cruise ships], sport, drowning, mass casualty incidents), and specific patient groups (asthma and chronic obstructive pulmonary disease, neurological disease, morbid obesity, pregnancy).
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Affiliation(s)
- Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Deutschland
| | - Anatolij Truhlář
- Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Tschechien
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Králové, Charles University in Prague, Hradec Králové, Tschechien
| | - Anette Alfonzo
- Departments of Renal and Internal Medicine, Victoria Hospital, Kirkcaldy, Fife Großbritannien
| | - Alessandro Barelli
- Anaesthesiology and Intensive Care, Teaching and research Unit, Emergency Territorial Agency ARES 118, Catholic University School of Medicine, Rom, Italien
| | - Violeta González-Salvado
- Cardiology Department, University Clinical Hospital of Santiago de Compostela, Institute of Health Research of Santiago de Compostela (IDIS), Biomedical Research Networking Centres on Cardiovascular Disease (CIBER-CV), A Coruña, Spanien
| | - Jochen Hinkelbein
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Köln, Deutschland
| | - Jerry P. Nolan
- Resuscitation Medicine, Warwick Medical School, University of Warwick, CV4 7AL Coventry, Großbritannien
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, BA1 3NG Bath, Großbritannien
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Österreich
| | - Gavin D. Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, Großbritannien
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, Großbritannien
| | - Karl-Christian Thies
- Dep. of Anesthesiology and Critical Care, Bethel Evangelical Hospital, University Medical Center OLW, Bielefeld University, Bielefeld, Deutschland
| | - Joyce Yeung
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, Großbritannien
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, Großbritannien
| | | | - Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, Großbritannien
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10
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Mørk SR, Stengaard C, Linde L, Møller JE, Jensen LO, Schmidt H, Riber LP, Andreasen JB, Thomassen SA, Laugesen H, Freeman PM, Christensen S, Greisen JR, Tang M, Møller-Sørensen PH, Holmvang L, Gregers E, Kjaergaard J, Hassager C, Eiskjær H, Terkelsen CJ. Mechanical circulatory support for refractory out-of-hospital cardiac arrest: a Danish nationwide multicenter study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:174. [PMID: 34022934 PMCID: PMC8141159 DOI: 10.1186/s13054-021-03606-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/14/2021] [Indexed: 12/16/2022]
Abstract
Background Mechanical circulatory support (MCS) with either extracorporeal membrane oxygenation or Impella has shown potential as a salvage therapy for patients with refractory out-of-hospital cardiac arrest (OHCA). The objective of this study was to describe the gradual implementation, survival and adherence to the national consensus with respect to use of MCS for OHCA in Denmark, and to identify factors associated with outcome. Methods This retrospective, observational cohort study included patients receiving MCS for OHCA at all tertiary cardiac arrest centers (n = 4) in Denmark between July 2011 and December 2020. Logistic regression and Kaplan–Meier survival analysis were used to determine association with outcome. Outcome was presented as survival to hospital discharge with good neurological outcome, 30-day survival and predictors of 30-day mortality. Results A total of 259 patients were included in the study. Thirty-day survival was 26%. Sixty-five (25%) survived to hospital discharge and a good neurological outcome (Glasgow–Pittsburgh Cerebral Performance Categories 1–2) was observed in 94% of these patients. Strict adherence to the national consensus showed a 30-day survival rate of 30% compared with 22% in patients violating one or more criteria. Adding criteria to the national consensus such as signs of life during cardiopulmonary resuscitation (CPR), pre-hospital low-flow < 100 min, pH > 6.8 and lactate < 15 mmol/L increased the survival rate to 48%, but would exclude 58% of the survivors from the current cohort. Logistic regression identified asystole (RR 1.36, 95% CI 1.18–1.57), pulseless electrical activity (RR 1.20, 95% CI 1.03–1.41), initial pH < 6.8 (RR 1.28, 95% CI 1.12–1.46) and lactate levels > 15 mmol/L (RR 1.16, 95% CI 1.16–1.53) as factors associated with increased risk of 30-day mortality. Patients presenting signs of life during CPR had reduced risk of 30-day mortality (RR 0.63, 95% CI 0.52–0.76). Conclusions A high survival rate with a good neurological outcome was observed in this Danish population of patients treated with MCS for OHCA. Stringent patient selection for MCS may produce higher survival rates but potentially withholds life-saving treatment in a significant proportion of survivors. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03606-5.
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Affiliation(s)
- Sivagowry Rasalingam Mørk
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Carsten Stengaard
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Louise Linde
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | | | - Henrik Schmidt
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Lars Peter Riber
- Department of Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Jo Bønding Andreasen
- Department of Anaesthesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Sisse Anette Thomassen
- Department of Anaesthesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Helle Laugesen
- Department of Anaesthesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | | | - Steffen Christensen
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Jacob Raben Greisen
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Mariann Tang
- Department of Thoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lene Holmvang
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Emilie Gregers
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hans Eiskjær
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Christian Juhl Terkelsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.,The Danish Heart Foundation, Copenhagen, Denmark
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11
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McGovern L, Cosgrave J. Axial flow ventricular assist devices in cardiogenic shock complicating acute myocardial infarction. Heart 2021; 107:1856-1861. [PMID: 33811130 DOI: 10.1136/heartjnl-2020-318226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 02/12/2021] [Accepted: 02/17/2021] [Indexed: 11/04/2022] Open
Abstract
Cardiogenic shock (CS) remains the leading cause of death in patients hospitalised with acute myocardial infarction with mortality as high as 40%-50% prior to hospital discharge. The failure of inotropic therapy to maintain adequate perfusion and to prevent irreversible end-organ failure has led to attempts to improve outcomes by mechanical circulatory support (MCS) devices. Axial flow ventricular assist devices, namely Impella, are an attractive therapeutic option due to their positive haemodynamic benefits and ease of use. Despite clear beneficial haemodynamic effects, which should significantly impact on the pathophysiology of CS, there are currently no clear data to support their use in the reduction of clinical end points such as cardiac death. This review summarises and critically evaluates the current scientific evidence for the use of axial flow ventricular assist devices and highlights gaps in our understanding. Given such gaps, a consensus multidisciplinary approach, predicated on emphasising timely diagnosis and appropriate use of MCS, is vital to ensure that the right patient is paired with the right device at the right time.
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12
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Lott C, Truhlář A, Alfonzo A, Barelli A, González-Salvado V, Hinkelbein J, Nolan JP, Paal P, Perkins GD, Thies KC, Yeung J, Zideman DA, Soar J. European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances. Resuscitation 2021; 161:152-219. [PMID: 33773826 DOI: 10.1016/j.resuscitation.2021.02.011] [Citation(s) in RCA: 328] [Impact Index Per Article: 109.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
These European Resuscitation Council (ERC) Cardiac Arrest in Special Circumstances guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the modifications required to basic and advanced life support for the prevention and treatment of cardiac arrest in special circumstances; specifically special causes (hypoxia, trauma, anaphylaxis, sepsis, hypo/hyperkalaemia and other electrolyte disorders, hypothermia, avalanche, hyperthermia and malignant hyperthermia, pulmonary embolism, coronary thrombosis, cardiac tamponade, tension pneumothorax, toxic agents), special settings (operating room, cardiac surgery, catheter laboratory, dialysis unit, dental clinics, transportation (in-flight, cruise ships), sport, drowning, mass casualty incidents), and special patient groups (asthma and COPD, neurological disease, obesity, pregnancy).
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Affiliation(s)
- Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-University Mainz, Germany.
| | - Anatolij Truhlář
- Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Czech Republic; Department of Anaesthesiology and Intensive Care Medicine, Charles University in Prague, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Annette Alfonzo
- Departments of Renal and Internal Medicine, Victoria Hospital, Kirkcaldy, Fife, UK
| | - Alessandro Barelli
- Anaesthesiology and Intensive Care, Catholic University School of Medicine, Teaching and Research Unit, Emergency Territorial Agency ARES 118, Rome, Italy
| | - Violeta González-Salvado
- Cardiology Department, University Clinical Hospital of Santiago de Compostela, Institute of Health Research of Santiago de Compostela (IDIS), Biomedical Research Networking Centres on Cardiovascular Disease (CIBER-CV), A Coruña, Spain
| | - Jochen Hinkelbein
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Jerry P Nolan
- Resuscitation Medicine, University of Warwick, Warwick Medical School, Coventry, CV4 7AL, UK; Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, BA1 3NG, UK
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Gavin D Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Karl-Christian Thies
- Department of Anesthesiology, Critical Care and Emergency Medicine, Bethel Medical Centre, OWL University Hospitals, Bielefeld University, Germany
| | - Joyce Yeung
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK
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13
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Management of In-laboratory Cardiopulmonary Arrest. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-021-00909-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Zilio F, Muraglia S, Bonmassari R. Cardiac arrest complicating cardiogenic shock: from pathophysiological insights to Impella-assisted cardiopulmonary resuscitation in a pheochromocytoma-induced Takotsubo cardiomyopathy—a case report. Eur Heart J Case Rep 2021; 5:ytab092. [PMID: 34113770 PMCID: PMC8186919 DOI: 10.1093/ehjcr/ytab092] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/21/2020] [Accepted: 02/23/2021] [Indexed: 11/25/2022]
Abstract
Background A ‘catecholamine storm’ in a case of pheochromocytoma can lead to a transient left ventricular dysfunction similar to Takotsubo cardiomyopathy. A cardiogenic shock can thus develop, with high left ventricular end-diastolic pressure and a reduction in coronary perfusion pressure. This scenario can ultimately lead to a cardiac arrest, in which unloading the left ventricle with a peripheral left ventricular assist device (Impella®) could help in achieving the return of spontaneous circulation (ROSC). Case summary A patient affected by Takotsubo cardiomyopathy caused by a pheochromocytoma presented with cardiogenic shock that finally evolved into refractory cardiac arrest. Cardiopulmonary resuscitation was performed but ROSC was achieved only after Impella® placement. Discussion In the clinical scenario of Takotsubo cardiomyopathy due to pheochromocytoma, when cardiogenic shock develops treatment is difficult because exogenous catecholamines, required to maintain organ perfusion, could exacerbate hypertension and deteriorate the cardiomyopathy. Moreover, as the coronary perfusion pressure is critically reduced, refractory cardiac arrest could develop. Although veno-arterial extra-corporeal membrane oxygenation (va-ECMO) has been advocated as the treatment of choice for in-hospital refractory cardiac arrest, in the presence of left ventricular overload a device like Impella®, which carries fewer complications as compared to ECMO, could be effective in obtaining the ROSC by unloading the left ventricle.
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Affiliation(s)
- Filippo Zilio
- Department of Cardiology, Santa Chiara Hospital, 2, Largo Medaglie d’Oro, 38122 Trento, Italy
| | - Simone Muraglia
- Department of Cardiology, Santa Chiara Hospital, 2, Largo Medaglie d’Oro, 38122 Trento, Italy
| | - Roberto Bonmassari
- Department of Cardiology, Santa Chiara Hospital, 2, Largo Medaglie d’Oro, 38122 Trento, Italy
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Panagides V, Vase H, Shah SP, Basir MB, Mancini J, Kamran H, Batra S, Laine M, Eiskjær H, Christensen S, Karami M, Paganelli F, Henriques JPS, Bonello L. Impella CP Implantation during Cardiopulmonary Resuscitation for Cardiac Arrest: A Multicenter Experience. J Clin Med 2021; 10:jcm10020339. [PMID: 33477532 PMCID: PMC7831079 DOI: 10.3390/jcm10020339] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/08/2021] [Accepted: 01/15/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Impella CP is a left ventricular pump which may serve as a circulatory support during cardiopulmonary resuscitation (CPR) for cardiac arrest (CA). Nevertheless, the survival rate and factors associated with survival in patients undergoing Impella insertion during CPR for CA are unknown. METHODS We performed a retrospective multicenter international registry of patients undergoing Impella insertion during on-going CPR for in- or out-of-hospital CA. We recorded immediate and 30-day survival with and without neurologic impairment using the cerebral performance category score and evaluated the factors associated with survival. RESULTS Thirty-five patients had an Impella CP implanted during CPR for CA. Refractory ventricular arrhythmias were the most frequent initial rhythm (65.7%). In total, 65.7% of patients immediately survived. At 30 days, 45.7% of patients were still alive. The 30-day survival rate without neurological impairment was 37.1%. In univariate analysis, survival was associated with both an age < 75 years and a time from arrest to CPR ≤ 5 min (p = 0.035 and p = 0.008, respectively). CONCLUSIONS In our multicenter registry, Impella CP insertion during ongoing CPR for CA was associated with a 37.1% rate of 30-day survival without neurological impairment. The factors associated with survival were a young age and a time from arrest to CPR ≤ 5 min.
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Affiliation(s)
- Vassili Panagides
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France; (V.P.); (M.L.); (F.P.)
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France
- Centre for CardioVascular and Nutrition Research (C2VN), INSERM 1263, INRA 1260, 13015 Marseille, France
| | - Henrik Vase
- Department of Cardiology, Aarhus University Hospital, 8200 Aarhus, Denmark; (H.V.); (H.E.)
| | - Sachin P. Shah
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA 01805, USA; (S.P.S.); (H.K.); (S.B.)
| | - Mir B. Basir
- Department of Cardiology, Henry Ford Hospital, Detroit, MI 48202, USA;
| | - Julien Mancini
- Department of Public Health (BIOSTIC), Aix-Marseille University, INSERM, IRD, APHM, UMR1252, SESSTIM, Hôpital de la Timone, 13005 Marseille, France;
| | - Hayaan Kamran
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA 01805, USA; (S.P.S.); (H.K.); (S.B.)
| | - Supria Batra
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA 01805, USA; (S.P.S.); (H.K.); (S.B.)
| | - Marc Laine
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France; (V.P.); (M.L.); (F.P.)
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France
- Centre for CardioVascular and Nutrition Research (C2VN), INSERM 1263, INRA 1260, 13015 Marseille, France
| | - Hans Eiskjær
- Department of Cardiology, Aarhus University Hospital, 8200 Aarhus, Denmark; (H.V.); (H.E.)
| | - Steffen Christensen
- Department of Intensive Care Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark;
| | - Mina Karami
- Department of Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1081 HV Amsterdam, The Netherlands; (M.K.); (J.P.S.H.)
| | - Franck Paganelli
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France; (V.P.); (M.L.); (F.P.)
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France
- Centre for CardioVascular and Nutrition Research (C2VN), INSERM 1263, INRA 1260, 13015 Marseille, France
| | - Jose P. S. Henriques
- Department of Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1081 HV Amsterdam, The Netherlands; (M.K.); (J.P.S.H.)
| | - Laurent Bonello
- Intensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, 13015 Marseille, France; (V.P.); (M.L.); (F.P.)
- Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France
- Centre for CardioVascular and Nutrition Research (C2VN), INSERM 1263, INRA 1260, 13015 Marseille, France
- Correspondence: ; Tel.: +33-4-9196-7487
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Tram J, Pressman A, Chen NW, Berger DA, Miller J, Welch RD, Reynolds JC, Pribble J, Hanson I, Swor R. Percutaneous mechanical circulatory support and survival in patients resuscitated from Out of Hospital cardiac arrest: A study from the CARES surveillance group. Resuscitation 2020; 158:122-129. [PMID: 33253768 DOI: 10.1016/j.resuscitation.2020.10.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/15/2020] [Accepted: 10/05/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Maintenance of cardiac function is required for successful outcome after out-of-hospital cardiac arrest (OHCA). Cardiac function can be augmented using a mechanical circulatory support (MCS) device, most commonly an intra-aortic balloon pump (IABP) or Impella®. OBJECTIVE Our objective is to assess whether the use of a MCS is associated with improved survival in patients resuscitated from OHCA in Michigan. METHODS We matched cardiac arrest cases during 2014-2017 from the Cardiac Arrest Registry to Enhance Survival (CARES) in Michigan and the Michigan Inpatient Database (MIDB) using probabilistic linkage. Multilevel logistic regression tested the association between MCS and the primary outcome of survival to hospital discharge. RESULTS A total of 3790 CARES cases were matched with the MIDB and 1131 (29.8%) survived to hospital discharge. A small number were treated with MCS, an IABP (n = 183) or Impella® (n = 50). IABP use was associated with an improved outcome (unadjusted OR = 2.16, 95%CI [1.59, 2.93]), while use of Impella® approached significance (OR = 1.72, 95% CI [0.96, 3.06]). Use of MCS was associated with improved outcome (unadjusted OR = 2.07, 95% CI [1.55, 2.77]). In a multivariable model, MCS use was no longer independently associated with improved outcome (ORadj = 0.95, 95% CI [0.69, 1.31]). In the subset of subjects with cardiogenic shock (N = 725), MCS was associated with improved survival in univariate (unadjusted OR = 1.84, 95% CI [1.24, 2.73]) but not multi-variable modeling (ORadj = 1.14, 95% CI [0.74, 1.77]). CONCLUSION Use of MCS was infrequent in patients resuscitated from OHCA and was not independently associated with improvement in post arrest survival after adjusting for covariates.
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Affiliation(s)
- Julie Tram
- Oakland University William Beaumont School of Medicine
| | | | - Nai-Wei Chen
- Division of Informatics and Biostatistics, Beaumont Health
| | - David A Berger
- Beaumont Health System- Department of Emergency Medicine
| | - Joseph Miller
- Department of Emergency Medicine, Henry Ford Health System
| | - Robert D Welch
- Department of Emergency Medicine, Wayne State University
| | | | | | - Ivan Hanson
- Beaumont Health System, Department of Cardiovascular Medicine
| | - Robert Swor
- Beaumont Health System- Department of Emergency Medicine.
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Iannaccone M, Albani S, Giannini F, Colangelo S, Boccuzzi GG, Garbo R, Brilakis ES, D'ascenzo F, de Ferrari GM, Colombo A. Short term outcomes of Impella in cardiogenic shock: A review and meta-analysis of observational studies. Int J Cardiol 2020; 324:44-51. [PMID: 32971148 DOI: 10.1016/j.ijcard.2020.09.044] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The clinical impact of invasive hemodynamic support with Impella in patients with cardiogenic shock (CS) remains to be defined. METHOD Only studies including patients treated with Impella in CS were selected. The primary endpoint was short term mortality, while secondary endpoints were major vascular complications and major bleeding. RESULTS 17 studies and 3933 patients were included in the analysis. Median age was 61.9 (IQR 59.2-63.5) years, CS was mainly related to acute coronary syndrome (ACS): 79.6% (IQR 75.1-79.6). Thirty-day mortality was 47.8% (CI 43.7-52%). Based on metaregression analysis, the Impella 5.0 (point estimate -0.006, 95% CI -0.01 - - 0.02, p < 0.01) and the Impella CP (point estimate -0.007, 95% CI -0.01 - - 0.03, p < 0.01) devices were related to a higher survival rate, whereas the Impella 2.5 was not. Furthermore, a correlation with reduced mortality was found when Impella was initiated in CS not complicated by cardiac arrest (CA), and before revascularization, (point estimate 0.01, 95% CI 0.002-0.02, p < 0.01 and point estimate -0.02, 95% CI 0.023-0.01, p < 0.001 respectively). The vascular complication and major bleeding rate were 7.4% (95% CI 5.6-9.6%) and 15.2% (95% CI 10.7-21%) respectively, and were associated with older age and comorbidities, while the implantation of an Impella CP/2.5 L was associated with fewer complications. CONCLUSIONS Despite the use of Impella the 30 day mortality of CS still remains high. Our data suggest that the use of an Impella CP, initiation of Impella prior to PCI and in patients without cardiac arrest was correlated with outcome improvements.
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Affiliation(s)
- Mario Iannaccone
- Department of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy.
| | - Stefano Albani
- Department of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Salvatore Colangelo
- Department of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Giacomo G Boccuzzi
- Department of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Roberto Garbo
- Department of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute at Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, MN, United States of America
| | - Fabrizio D'ascenzo
- Department of Cardiology, Città della scienza e della Salute, University of Turin, Turin, Italy
| | | | - Antonio Colombo
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
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Lotun K, Truong HT, Cha KC, Alsakka H, Gianotto-Oliveira R, Smith N, Rao P, Bien T, Chatelain S, Kern MC, Hsu CH, Zuercher M, Kern KB. Cardiac Arrest in the Cardiac Catheterization Laboratory: Combining Mechanical Chest Compressions and Percutaneous LV Assistance. JACC Cardiovasc Interv 2020; 12:1840-1849. [PMID: 31537284 DOI: 10.1016/j.jcin.2019.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/29/2019] [Accepted: 05/14/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the optimal treatment approach for cardiac arrest (CA) occurring in the cardiac catheterization laboratory. BACKGROUND CA can occur in the cath lab during high-risk percutaneous coronary intervention. While attempting to correct the precipitating cause of CA, several options are available to maintain vital organ perfusion. These include manual chest compressions, mechanical chest compressions, or a percutaneous left ventricular assist device. METHODS Eighty swine (58 ± 10 kg) were studied. The left main or proximal left anterior descending artery was occluded. Ventricular fibrillation (VFCA) was induced and circulatory support was provided with 1 of 4 techniques: either manual chest compressions (frequently interrupted), mechanical chest compressions with a piston device (LUCAS-2), an Impella 2.5 L percutaneously placed LVAD, or the combination of mechanical chest compressions and the percutaneous left ventricular assist device. The study protocol included 12 min of left main coronary occlusion, reperfusion, with defibrillation attempted after 15 min of VFCA. Primary outcome was favorable neurological function (CPC 1 or 2) at 24 h, while secondary outcomes included return of spontaneous circulation and hemodynamics. RESULTS Manual chest compressions provided fewer neurologically intact surviving animals than the combination of a mechanical chest compressor and a percutaneous LVAD device (0% vs. 56%; p < 0.01), while no difference was found between the 2 mechanical approaches (28% vs. 35%: p = 0.75). Comparing integrated coronary perfusion pressure showed sequential improvement in hemodynamic support with mechanical devices (401 ± 230 vs. 1,337 ± 905 mm Hg/s; p = 0.06). CONCLUSIONS Combining 2 mechanical devices provided superior 24-h survival with favorable neurological recovery compared with manual compressions during moderate duration VFCA associated with an acute coronary occlusion in the animal catheterization laboratory.
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Affiliation(s)
- Kapildeo Lotun
- Department of Medicine, University of Arizona Sarver Heart Center, Tucson, Arizona
| | - Huu Tam Truong
- Department of Medicine, University of Arizona Sarver Heart Center, Tucson, Arizona
| | - Kyoung-Chul Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju-si, Republic of Korea
| | - Hanan Alsakka
- Department of Medicine, University of Arizona Sarver Heart Center, Tucson, Arizona
| | - Renan Gianotto-Oliveira
- Department of Medicine, Heart Institute (InCor), School of Medicine, Sao Paulo University, Sao Paulo, Brazil
| | - Nicole Smith
- Department of Medicine, University of Arizona Sarver Heart Center, Tucson, Arizona
| | - Prashant Rao
- Department of Medicine, University of Arizona Sarver Heart Center, Tucson, Arizona
| | - Tyler Bien
- Department of Medicine, University of Arizona Sarver Heart Center, Tucson, Arizona
| | - Shaun Chatelain
- Department of Medicine, University of Arizona Sarver Heart Center, Tucson, Arizona
| | - Matthew C Kern
- Department of Medicine, University of Arizona Sarver Heart Center, Tucson, Arizona
| | - Chiu-Hsieh Hsu
- University of Arizona College of Public Health, Tucson, Arizona
| | - Mathias Zuercher
- Department of Anesthesiology, University of Basel, Basel, Switzerland
| | - Karl B Kern
- Department of Medicine, University of Arizona Sarver Heart Center, Tucson, Arizona.
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Outcomes of Impella CP insertion during cardiac arrest: A single center experience. Resuscitation 2020; 147:53-56. [DOI: 10.1016/j.resuscitation.2019.12.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 12/10/2019] [Accepted: 12/19/2019] [Indexed: 11/18/2022]
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Pareek N, Kordis P, Webb I, Noc M, MacCarthy P, Byrne J. Contemporary Management of Out-of-hospital Cardiac Arrest in the Cardiac Catheterisation Laboratory: Current Status and Future Directions. Interv Cardiol 2019; 14:113-123. [PMID: 31867056 PMCID: PMC6918505 DOI: 10.15420/icr.2019.3.2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 07/22/2019] [Indexed: 02/06/2023] Open
Abstract
Out-of-hospital cardiac arrest (OHCA) is an important cause of mortality and morbidity in developed countries and remains an important public health burden. A primary cardiac aetiology is common in OHCA patients, and so patients are increasingly brought to specialist cardiac centres for consideration of coronary angiography, percutaneous coronary intervention and mechanical circulatory support. This article focuses on the management of OHCA in the cardiac catheterisation laboratory. In particular, it addresses conveyance of the OHCA patient direct to a specialist centre, the role of targeted temperature management, pharmacological considerations, provision of early coronary angiography and mechanical circulatory support.
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Affiliation(s)
- Nilesh Pareek
- King’s College Hospital NHS Foundation TrustLondon, UK
- School of Cardiovascular Medicine & Sciences, BHF Centre of ExcellenceKing’s College London, UK
| | | | - Ian Webb
- King’s College Hospital NHS Foundation TrustLondon, UK
| | - Marko Noc
- University Medical CentreLjubljana, Slovenia
| | - Philip MacCarthy
- School of Cardiovascular Medicine & Sciences, BHF Centre of ExcellenceKing’s College London, UK
| | - Jonathan Byrne
- King’s College Hospital NHS Foundation TrustLondon, UK
- School of Cardiovascular Medicine & Sciences, BHF Centre of ExcellenceKing’s College London, UK
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21
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Cui CQ, Cook BS, Cauchi MP, Foerst JR. A case series: alternative access for refractory shock during cardiac arrest. Eur Heart J Case Rep 2019; 3:ytz101. [PMID: 31660478 PMCID: PMC6764545 DOI: 10.1093/ehjcr/ytz101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/20/2019] [Accepted: 06/19/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND In patients with iliofemoral arterial disease, transcaval and percutaneous axillary artery access are safe alternatives for delivery of transcatheter aortic valve replacement for severe aortic stenosis. In the setting of cardiac arrest, arterial access is crucial for delivery of mechanical circulatory support devices such as an Impella CP® or cannulation for extracorporeal cardiopulmonary resuscitation (ECMO). We report the use of transcaval and axillary artery access in three cases of cardiac arrest in which the emergent placement of an Impella CP® (Abiomed, Danvers, MA, USA) or cannulation for ECMO was instrumental in resuscitation from refractory cardiac arrest. CASE SUMMARY The first patient is a 59-year-old woman who developed ventricular fibrillation arrest after percutaneous intervention with emergent placement of a transcaval Impella CP®. In the second case, a 67-year-old man with coronary vasospasm developed cardiac arrest with an axillary artery Impella CP® placed. The third case highlights a 67-year-old man who developed cardiac arrest 1 day after unsuccessful chronic total occlusion repair requiring ECMO cannulation to his axillary artery. All three patients achieved spontaneous circulation after placement of assist devices. DISCUSSION To our knowledge, a case report of transcaval or percutaneous axillary artery access for Impella CP® during cardiac arrest has not been published. While the long-term prognosis following cardiac arrest is poor, younger patients deserve every chance for survival with rapid cardiopulmonary support by alternative access if necessary. Advanced large bore alternative access techniques should be learned by all interventional operators.
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Affiliation(s)
- Charles Q Cui
- Section of Cardiology, Virginia Tech-Carilion School of Medicine, 2001 Crystal Springs Ave, Roanoke, VA, USA
| | - Bryon S Cook
- Section of Cardiology, Virginia Tech-Carilion School of Medicine, 2001 Crystal Springs Ave, Roanoke, VA, USA
| | - Matthew P Cauchi
- Section of Cardiology, Virginia Tech-Carilion School of Medicine, 2001 Crystal Springs Ave, Roanoke, VA, USA
| | - Jason R Foerst
- Section of Cardiology, Virginia Tech-Carilion School of Medicine, 2001 Crystal Springs Ave, Roanoke, VA, USA
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22
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Rohm CL, Gadidov B, Leitson M, Ray HE, Prasad R. Predictors of Mortality and Outcomes of Acute Severe Cardiogenic Shock Treated with the Impella Device. Am J Cardiol 2019; 124:499-504. [PMID: 31262498 DOI: 10.1016/j.amjcard.2019.05.039] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/30/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022]
Abstract
The Impella (Abiomed, Danvers, Massachusetts) device is increasingly used for mechanical circulatory support (MCS) to treat acute severe cardiogenic shock (CS). Initial and continued determination of the appropriate degree of MCS is challenging. This study evaluates predictors of mortality in patients treated with the Impella for acute severe CS and outcomes associated with prolonged Impella use. This retrospective single-center study included 204 patients treated with the Impella 2.5, Impella CP, or Impella 5.0 from 2011 to 2018 for acute severe CS. The primary end point was all-cause in-hospital mortality. All-cause in-hospital mortality was 45.1%. Nonsurvivors had a lower initial pH (7.24 vs 7.32, hazard ratio [HR] 1.03, p <0.0001), lower serum CO2 (19.1 vs 21.3 mmol/L, HR 1.08, p = 0.002), higher lactate (6.8 vs 3.3 mmol/L, HR 1.17, p <0.0001), and used a greater number of vasopressors and inotropes (4.3 vs 2.6, HR 1.44, p <0.0001). Patients with the Impella >4 days (n = 45) had a longer intensive care unit stay (12.6 vs 6.9 days, p <0.001), longer total hospital stay (16.4 vs 11.6 days, p = 0.03), longer mechanical ventilation use (7.8 vs 4.4 days, p = 0.002), and trend toward increased mortality (57.8 vs 41.5%, p = 0.051). In conclusion, in patients treated with the Impella for acute severe CS, initial biochemical parameters and need for vasopressors and inotropes are significant predictors of mortality that can serve as valuable indicators of whether the Impella or higher level of MCS is more appropriate. Patients treated with the Impella beyond 4 days have poorer outcomes and may benefit from escalation of care.
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23
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Persico N, Guervilly C, Verhamme B, Bonello L. Using an Impella device to reverse refractory cardiac arrest and enable efficient coronary revascularisation. BMJ Case Rep 2019; 12:12/8/e230654. [PMID: 31401583 DOI: 10.1136/bcr-2019-230654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report the case of a 54-year-old man who suffered from refractory cardiac arrest secondary to acute myocardial infarction. As veno-arterial extracorporeal membrane oxygenation was unavailable, mechanical chest compression was performed and an Impella device was used that immediately delivered at 3.2 l/min flow to reach the optimal mean arterial pressure. Within 1 min, return of spontaneous circulation was achieved and a 40% left ventricular ejection fraction was measured on echography. Then, the right coronary artery could be revascularised. Despite 62 min low flow, the patient was discharged home on day 19 without neurological sequelae. During refractory cardiac arrest, the European Resuscitation Guidelines indicate that veno-arterial extracorporeal membrane oxygenation should be considered as rescue therapy. Other mechanical circulatory supports such as an Impella device (left ventricular assist device propelling blood in the ascending aorta) can be a promising treatment in select patients; however, insufficient data in humans are available.
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Affiliation(s)
- Nicolas Persico
- Emergency Department, Assistance Publique - Hôpitaux de Marseille, Marseille, France
- CEReSS - Health Service Research and Quality of Life Center EA 3279, Aix-Marseille Université, Marseille, France
| | - Christophe Guervilly
- CEReSS - Health Service Research and Quality of Life Center EA 3279, Aix-Marseille Université, Marseille, France
- Réanimation des Détresses Respiratoires et des Infections Sévères, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Baptiste Verhamme
- Emergency Department, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Laurent Bonello
- Department of Cardiology, Intensive Care Unit, Assistance Publique - Hôpitaux de Marseille, Marseille, France
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Abstract
PURPOSE OF REVIEW Temporary circulatory support (TCS) with short-term mechanical circulatory support (MCS) devices is increasingly used as a salvage therapy for patients with refractory cardiogenic shock. This article provides an overview of current devices, their indications and management, and discusses results of recent case series and trials. RECENT FINDINGS Percutaneous active MCS devices (Impella, TandemHeart…) and venoarterial extracorporeal membrane oxygenation (VA-ECMO) are utilized as a bridge to 'decision' that includes weaning after cardiac function recovery, transplantation, long-term MCS and withdrawal in case of futility. VA-ECMO is considered the first-line TCS since it allows rapid improvement in oxygenation, is less expensive, and is also suitable for patients with biventricular failure. Combining Impella or intra-aortic balloon pump support with ECMO might decrease left ventricular pressure and improve outcomes. Sepsis-associated cardiomyopathy, massive pulmonary embolism, arrhythmic storm and Takotsubo-like cardiomyopathy are among emerging indications for TCS. SUMMARY TCS have become the cornerstone of the management of patients with cardiogenic shock, although the evidence supporting their efficacy is limited. VA-ECMO is considered the first-line option, with a growing number of accepted and emerging indications. Randomized clinical trials are now needed to determine the respective place of different MCS devices in cardiogenic shock treatment strategies.
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25
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Shinar Z. Is the "Unprotected Heart" a clinical myth? Use of IABP, Impella, and ECMO in the acute cardiac patient. Resuscitation 2019; 140:205-206. [PMID: 31125528 DOI: 10.1016/j.resuscitation.2019.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 05/06/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Zachary Shinar
- Sharp Memorial Hospital, Emergency Department, 7901 Frost St, San Diego, CA 92130, United States.
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Letzen B, Park J, Tuzun Z, Bonde P. Design and Development of a Miniaturized Percutaneously Deployable Wireless Left Ventricular Assist Device: Early Prototypes and Feasibility Testing. ASAIO J 2019; 64:147-153. [PMID: 28938307 PMCID: PMC5823723 DOI: 10.1097/mat.0000000000000669] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The current left ventricular assist devices (LVADs) are limited by a highly invasive implantation procedure in a severely unstable group of advanced heart failure patients. Additionally, the current transcutaneous power drive line acts as a nidus for infection resulting in significant morbidity and mortality. In an effort to decrease this invasiveness and eliminate drive line complications, we have conceived a wireless miniaturized percutaneous LVAD, capable of being delivered endovascularly with a tether-free operation. The system obviates the need for a transcutaneous fluid purge line required in existing temporary devices by utilizing an incorporated magnetically coupled impeller for a complete seal. The objective of this article was to demonstrate early development and proof-of-concept feasibility testing to serve as the groundwork for future formalized device development. Five early prototypes were designed and constructed to iteratively minimize the pump size and improve fluid dynamic performance. Various magnetic coupling configurations were tested. Using SolidWorks and ANSYS software for modeling and simulation, several geometric parameters were varied. HQ curves were constructed from preliminary in vitro testing to characterize the pump performance. Bench top tests showed no-slip magnetic coupling of the impeller to the driveshaft up to the current limit of the motor. The pump power requirements were tested in vitro and were within the appropriate range for powering via a wireless energy transfer system. Our results demonstrate the proof-of-concept feasibility of a novel endovascular cardiac assist device with the potential to eventually offer patients an untethered, minimally invasive support.
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Affiliation(s)
- Brian Letzen
- Bonde Artificial Heart Lab, Yale School of Medicine, New Haven, CT
| | - Jiheum Park
- Bonde Artificial Heart Lab, Yale School of Medicine, New Haven, CT
| | - Zeynep Tuzun
- Bonde Artificial Heart Lab, Yale School of Medicine, New Haven, CT
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27
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Patel NJ, Atti V, Kumar V, Panakos A, Anantha Narayanan M, Bhardwaj B, Arora S, Deshmukh AJ, Patel N, Basir MB, Cohen MG, Kini AS, Sharma SK, Dangas G, O'Neill WW, Alfonso CE. Temporal trends of survival and utilization of mechanical circulatory support devices in patients with in‐hospital cardiac arrest secondary to ventricular tachycardia/ventricular fibrillation. Catheter Cardiovasc Interv 2019; 94:578-587. [DOI: 10.1002/ccd.28138] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/30/2018] [Accepted: 01/28/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Nileshkumar J. Patel
- Department of Cardiovascular diseasesThe Icahn School of Medicine at Mount Sinai New York New York
| | - Varunsiri Atti
- Department of MedicineMichigan State University‐Sparrow Hospital East Lansing Michigan
| | - Varun Kumar
- Division of Cardiovascular DiseasesMt Sinai St Luke's Roosevelt New York New York
| | - Andrew Panakos
- Division of Cardiovascular diseases, Department of MedicineUniversity of Miami‐Miller School of Medicine Miami Florida
| | | | - Bhaskar Bhardwaj
- Division of Cardiovascular DiseasesUniversity of Missouri Columbia Missouri
| | - Shilpkumar Arora
- Department of MedicineGuthrie Robert Packer Hospital Sayre Pennsylvania
| | | | - Nish Patel
- Department of Cardiovascular diseasesThe Icahn School of Medicine at Mount Sinai New York New York
| | - Mir B. Basir
- Division of Cardiovascular DiseasesHenry Ford Health System Detroit Michigan
| | - Mauricio G. Cohen
- Division of Cardiovascular diseases, Department of MedicineUniversity of Miami‐Miller School of Medicine Miami Florida
| | - Annapoorna S. Kini
- Department of Cardiovascular diseasesThe Icahn School of Medicine at Mount Sinai New York New York
| | - Samin K. Sharma
- Department of Cardiovascular diseasesThe Icahn School of Medicine at Mount Sinai New York New York
| | - George Dangas
- Department of Cardiovascular diseasesThe Icahn School of Medicine at Mount Sinai New York New York
| | - William W. O'Neill
- Division of Cardiovascular DiseasesHenry Ford Health System Detroit Michigan
| | - Carlos E. Alfonso
- Division of Cardiovascular diseases, Department of MedicineUniversity of Miami‐Miller School of Medicine Miami Florida
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Ouweneel DM, de Brabander J, Karami M, Sjauw KD, Engström AE, Vis MM, Wykrzykowska JJ, Beijk MA, Koch KT, Baan J, de Winter RJ, Piek JJ, Lagrand WK, Cherpanath TG, Driessen AH, Cocchieri R, de Mol BA, Tijssen JG, Henriques JP. Real-life use of left ventricular circulatory support with Impella in cardiogenic shock after acute myocardial infarction: 12 years AMC experience. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2018; 8:338-349. [PMID: 30403366 PMCID: PMC6616211 DOI: 10.1177/2048872618805486] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS Mortality in cardiogenic shock patients remains high. Short-term mechanical circulatory support with Impella can be used to support the circulation in these patients, but data from randomised controlled studies and 'real-world' data are sparse. The aim is to describe real-life data on outcomes and complications of our 12 years of clinical experience with Impella in patients with cardiogenic shock after acute myocardial infarction and to identify predictors of 6-month mortality. METHODS We describe a single-centre registry from October 2004 to December 2016 including all patients treated with Impella for cardiogenic shock after acute myocardial infarction. We report outcomes and complications and identify predictors of 6-month mortality. RESULTS Our overall clinical experience consists of 250 patients treated with Impella 2.5, Impella CP or Impella 5.0. A total of 172 patients received Impella therapy for cardiogenic shock, of which 112 patients had cardiogenic shock after acute myocardial infarction. The mean age was 60.1±10.6 years, mean arterial pressure was 67 (56-77) mmHg, lactate was 6.2 (3.6-9.7) mmol/L, 87.5% were mechanically ventilated and 59.6% had a cardiac arrest before Impella placement. Overall 30-day mortality was 56.2% and 6-month mortality was 60.7%. Complications consisted of device-related vascular complications (17.0%), non-device-related bleeding (12.5%), haemolysis (7.1%) and stroke (3.6%). In a multivariate analysis, pH before Impella placement is a predictor of 6-month mortality. CONCLUSIONS Our registry shows that Impella treatment in cardiogenic shock after acute myocardial infarction is feasible, although mortality rates remain high and complications occur.
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Affiliation(s)
- Dagmar M Ouweneel
- 1 Heart Center; department of Cardiology, Amsterdam UMC, The Netherlands
| | | | - Mina Karami
- 1 Heart Center; department of Cardiology, Amsterdam UMC, The Netherlands
| | - Krischan D Sjauw
- 1 Heart Center; department of Cardiology, Amsterdam UMC, The Netherlands
| | | | - M Marije Vis
- 1 Heart Center; department of Cardiology, Amsterdam UMC, The Netherlands
| | | | - Marcel A Beijk
- 1 Heart Center; department of Cardiology, Amsterdam UMC, The Netherlands
| | - Karel T Koch
- 1 Heart Center; department of Cardiology, Amsterdam UMC, The Netherlands
| | - Jan Baan
- 1 Heart Center; department of Cardiology, Amsterdam UMC, The Netherlands
| | | | - Jan J Piek
- 1 Heart Center; department of Cardiology, Amsterdam UMC, The Netherlands
| | - Wim K Lagrand
- 2 Department of Intensive Care Medicine, Amsterdam UMC, The Netherlands
| | | | | | - Riccardo Cocchieri
- 1 Heart Center; department of Cardiology, Amsterdam UMC, The Netherlands
| | - Bas Ajm de Mol
- 1 Heart Center; department of Cardiology, Amsterdam UMC, The Netherlands
| | - Jan Gp Tijssen
- 1 Heart Center; department of Cardiology, Amsterdam UMC, The Netherlands
| | - José Ps Henriques
- 1 Heart Center; department of Cardiology, Amsterdam UMC, The Netherlands
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Dogan G, Hanke J, Puntigam J, Haverich A, Schmitto JD. Hemoadsorption in cardiac shock with bi ventricular failure and giant-cell myocarditis: A case report. Int J Artif Organs 2018; 41:474-479. [PMID: 29843541 DOI: 10.1177/0391398818777362] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE Giant-cell myocarditis represents a rare and often fatal autoimmune disorder. Despite extracorporeal life support being a valid treatment option, alternatives to control the underlying inflammatory response remain sparse. A new hemoadsorption device (CytoSorb) has recently been introduced to treat patients with an excessive inflammatory response. METHODS A 57-year-old patient developed fulminant right heart failure, respiratory insufficiency, hemodynamic instability, and oliguric-anuric renal failure. An extracorporeal life support together with an Impella was implanted for circulatory support. Due to non-pulsatility, acontractility of the left ventricle and a heavily reduced right ventricular function, a left ventricular assist device implantation and change from extracorporeal life support to veno-pulmonary arterial extracorporeal membrane oxygenation was performed. Since adequate hemodynamic stabilization could not be achieved and due to increasing inflammatory mediators and bilirubin levels, the decision was made to additionally integrate a CytoSorb hemoadsorber into the system. RESULTS The combined treatment resulted in a clear and steady improvement in hemodynamics and the inflammatory condition with marked reductions in all measured parameters throughout the treatment period. Metabolic acidosis resolved and liver function improved. CONCLUSION Extracorporeal life support therapy represents a bridging approach to heart transplantation or to cardiac recovery and can be complemented by CytoSorb as an independent therapeutic option. The patient described herein with giant-cell myocarditis and fulminant cardiac failure who received substantial extracorporeal support in combination with CytoSorb hemoadsorption therapy benefited in terms of an improvement of organ function and his inflammatory situation.
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Affiliation(s)
- Günes Dogan
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jasmin Hanke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jakob Puntigam
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan D Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Yadav K, Truong HT. Cardiac Arrest in the Catheterization Laboratory. Curr Cardiol Rev 2018; 14:115-120. [PMID: 29741141 PMCID: PMC6088444 DOI: 10.2174/1573403x14666180509144512] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/30/2018] [Accepted: 04/25/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cardiac arrest in the Catheterization Lab is a rare and unique scenario that is often logistically challenging. It often has dire prognosis especially in patients suffering from severe pre-existing illnesses (high risk patient) such as acute myocardial infarction with cardiogenic shock, or patients undergoing high risk procedures. As the number of complex interventional procedures increases, cardiac arrest in the cath lab will become more common and optimal management of this scenario is critical for both the patient and operator. CONCLUSION In this review, we will discuss the special challenges during the resuscitation efforts in cath lab, especially with tradition chest compression. We will discuss the alternative options including mechanical compression devices and Invasive Percutaneous Mechanical Circulatory Support Devices. Finally, we will offer management suggestions on selecting the appropriate circulatory support device based on clinical and anatomic risks.
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Affiliation(s)
- Kapil Yadav
- College of Medicine, University of Arizona, Arizona, AZ 85724, Iran
| | - Huu Tam Truong
- College of Medicine, University of Arizona, Arizona, AZ 85724, Iran
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31
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Pressman A, Sawyer KN, Devlin W, Swor R. Association between percutaneous hemodynamic support device and survival from cardiac arrest in the state of Michigan. Am J Emerg Med 2018; 36:834-837. [DOI: 10.1016/j.ajem.2017.10.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 10/12/2017] [Accepted: 10/12/2017] [Indexed: 10/18/2022] Open
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32
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Ellert J, Jensen MJ, Jensen LO, Møller JE. Percutaneous biventricular cardiac assist device in cardiogenic shock and refractory cardiac arrest. EUROINTERVENTION 2018; 13:e2114-e2115. [PMID: 29039311 DOI: 10.4244/eij-d-17-00637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Julia Ellert
- Department of Cardiology, Odense University Hospital, Odense C, Denmark
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33
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Nalluri N, Patel N, Saouma S, Anugu VR, Anugula D, Asti D, Mehta V, Kumar V, Atti V, Edla S, Grewal RK, Khan HM, Kanotra R, Maniatis G, Kandov R, Lafferty JC, Dyal M, Alfonso CE, Cohen MG. Utilization of the Impella for hemodynamic support during percutaneous intervention and cardiogenic shock: an insight. Expert Rev Med Devices 2017; 14:789-804. [PMID: 28862481 DOI: 10.1080/17434440.2017.1374849] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Impella is a catheter-based micro-axial flow pump placed across the aortic valve, and it is currently the only percutaneous left ventricular assist device approved for high-risk percutaneous coronary intervention and cardiogenic shock. Areas Covered: Even though several studies have repeatedly demonstrated the excellent hemodynamic profile of Impella in high-risk settings, it remains underutilized. Here we aim to provide an up-to-date summary of the available literature on Impellas use in High risk settings as well as the practical aspects of its usage. Expert Commentary: Percutaneous coronary interventions in high rsk settings have always been challenging for a physician. Impella 2.5 and CP, have been proven safe, cost effective and feasible in High Risk Percutaneous coronary Interventions with an excellent hemodynamic profile.
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Affiliation(s)
- Nikhil Nalluri
- a Department of cardiology , Staten Island University Hospital , New York , NY , USA
| | - Nileshkumar Patel
- b Department of cardiology , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Samer Saouma
- a Department of cardiology , Staten Island University Hospital , New York , NY , USA
| | - Viswajit Reddy Anugu
- a Department of cardiology , Staten Island University Hospital , New York , NY , USA
| | - Dixitha Anugula
- c Department of Medicine , Creighton University School of Medicine , Omaha , NE , USA
| | - Deepak Asti
- a Department of cardiology , Staten Island University Hospital , New York , NY , USA
| | - Varshil Mehta
- d Department of Cardiology , Mount Sinai Hospital , Manhattan , NY
| | - Varun Kumar
- e Department of Cardiology , Mt. Sinai St. Luke's Roosevelt Hospital Center , New York , NY , USA
| | - Varunsiri Atti
- f Department of Medicine , Michigan State University , Lansing , MI , USA
| | - Sushruth Edla
- g St. John hospital and Medical Center , Cardiology , Detroit , MI , USA
| | - Rasleen K Grewal
- h Department of Medicine , Muhlenberg College , Allentown , PA , USA
| | - Hafiz M Khan
- a Department of cardiology , Staten Island University Hospital , New York , NY , USA
| | - Ritesh Kanotra
- i Department of medicine , Banner baywood medical center , Phoenix , AZ , USA
| | - Gregory Maniatis
- a Department of cardiology , Staten Island University Hospital , New York , NY , USA
| | - Ruben Kandov
- a Department of cardiology , Staten Island University Hospital , New York , NY , USA
| | - James C Lafferty
- a Department of cardiology , Staten Island University Hospital , New York , NY , USA
| | - Michael Dyal
- b Department of cardiology , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Carlos E Alfonso
- b Department of cardiology , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Mauricio G Cohen
- b Department of cardiology , University of Miami Miller School of Medicine , Miami , FL , USA
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Weiser C, Weihs W, Holzer M, Testori C, Kramer AM, Kment C, Stoiber M, Poppe M, Wallmüller C, Stratil P, Hoschitz M, Laggner A, Sterz F. Feasibility of profound hypothermia as part of extracorporeal life support in a pig model. J Thorac Cardiovasc Surg 2017; 154:867-874. [DOI: 10.1016/j.jtcvs.2017.03.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 02/02/2017] [Accepted: 03/04/2017] [Indexed: 10/19/2022]
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35
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[Coronary artery disease : Interventional and operative therapeutic options after cardiac arrest]. Herz 2017; 42:138-150. [PMID: 28229199 DOI: 10.1007/s00059-017-4546-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Coronary artery disease (CAD) represents a common structural cause for developing cardiac arrest in older patients, whereas in young adults cardiac arrest is more often caused by cardiomyopathies and cardiac channelopathies. A structural heart disease is known in almost 50% of patients prior to cardiac arrest. The present review outlines current interventional and operative therapeutic options for patients surviving cardiac arrest. The focus is on associations between epidemiological data on the incidence of malignant arrhythmias causing cardiac arrest depending on the presence or absence of CAD. Furthermore, the potential benefits of an early coronary revascularization as well as of a prompt complete coronary revascularization compared to the individual treatment of the so-called culprit lesion only are described. Finally, the advantages of invasive therapies for patients surviving cardiac arrest, such as targeted temperature management and mechanical cardiac assist devices, are elucidated. Cardiac assist devices comprise the use of the intra-aortic balloon pump (IABP) and devices for extracorporeal life support (ECLS) for peripheral and central support of the right and left heart chambers.
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Moving toward mechanical control of cardiac arrest. Resuscitation 2016; 112:A3-A4. [PMID: 27887957 DOI: 10.1016/j.resuscitation.2016.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 11/14/2016] [Indexed: 11/21/2022]
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