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Cormican DS, Madden C, Rodrigue MF. Mechanical circulatory support: complications, outcomes, and future directions. Int Anesthesiol Clin 2022; 60:72-80. [PMID: 35960687 DOI: 10.1097/aia.0000000000000373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Daniel S Cormican
- Cardiothoracic & Transplant Anesthesiology and Surgical Critical Care, Anesthesiology Institute, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Claire Madden
- Surgical Critical Care, Surgery Institute, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Marc F Rodrigue
- Cardiothoracic Anesthesiology, Anesthesiology Institute, Allegheny Health Network, Pittsburgh, Pennsylvania
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2
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González LS, Grady M. Intra-aortic balloon pump counterpulsation: technical function, management, and clinical indications. Int Anesthesiol Clin 2022; 60:16-23. [PMID: 35975922 DOI: 10.1097/aia.0000000000000379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Laura S González
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin
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3
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 145:e18-e114. [PMID: 34882435 DOI: 10.1161/cir.0000000000001038] [Citation(s) in RCA: 139] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIM The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. Structure: Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients' interests.
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 79:e21-e129. [PMID: 34895950 DOI: 10.1016/j.jacc.2021.09.006] [Citation(s) in RCA: 521] [Impact Index Per Article: 173.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. STRUCTURE Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients' interests.
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Son YJ, Lee HJ, Lim SH, Hong J, Seo EJ. Predictors of unplanned 30-day readmissions after coronary artery bypass graft: a systematic review and meta-analysis of cohort studies. Eur J Cardiovasc Nurs 2021; 20:717-725. [PMID: 33864067 DOI: 10.1093/eurjcn/zvab023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/26/2021] [Accepted: 03/10/2021] [Indexed: 11/14/2022]
Abstract
AIMS Coronary artery bypass graft (CABG) is one of the most performed cardiac surgery globally. CABG is known to have a high rate of short-term readmissions. The 30-day unplanned readmission rate as a quality measure is associated with adverse health outcomes. This study aimed to identify and synthesize the perioperative risk factors for 30-day unplanned readmission after CABG. METHODS AND RESULTS We systematically searched seven databases and reviewed studies to identify all eligible English articles published from 1 October 1999 to 30 September 2019. Random-effect models were employed to perform pooled analyses. Odds ratio and 95% confidence interval were used to estimate the risk factors for 30-day unplanned readmission. The 30-day hospital readmission rates after CABG ranged from 9.2% to 18.9% in 14 cohort studies. Among preoperative characteristics, older adults, female, weight loss, high serum creatinine, anticoagulant use or dialysis, and comorbidities were found to be statistically significant. Postoperative complications, prolonged length of hospital stay, and mechanical ventilation were revealed as the postoperative risk factors for 30-day unplanned readmission. However, intraoperative risk factors were not found to be significant in this review. CONCLUSION Our findings emphasize the importance of a comprehensive assessment during the perioperative period of CABG. Healthcare professionals can perform a readmission risk stratification and develop strategies to reduce readmission rates after CABG using the risk factors identified in this review. Future studies with prospective cohort samples are needed to identify the personal or psychosocial factors influencing readmission after CABG, including perioperative risk factors.
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Affiliation(s)
- Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, Seoul 06974, Republic of Korea
| | - Hyeon-Ju Lee
- Department of Nursing, Tongmyoung University, Busan 48520, Republic of Korea
| | - Sang-Hyun Lim
- Department of Thoracic and Cardiovascular Surgery, Ajou University, Suwon 16499, Republic of Korea
| | - Joonhwa Hong
- Department of Thoracic and Cardiovascular Surgery, Chung-Ang University, Seoul 06974, Republic of Korea
| | - Eun Ji Seo
- Ajou University College of Nursing and Research Institute of Nursing Science, 164, Worldcup-Ro, Yeongtong-Gu, Suwon 16499, Republic of Korea
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6
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Vetrovec GW, Lim MJ, Needham KA. Cost savings for pVAD compared to ECMO in the management of acute myocardial infarction complicated by cardiogenic shock: An episode-of-care analysis. Catheter Cardiovasc Interv 2020; 98:703-710. [PMID: 32790231 DOI: 10.1002/ccd.29181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/19/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Acute myocardial infarction complicated by cardiogenic shock (AMICS) occurs in up to 10% of acute myocardial infarction admissions and is associated with high mortality, frequent adverse outcomes, prolonged hospitalizations, extensive medical resource utilization, and major cost. Using hospital cost data for Medicare Fee-for-Service (FFS) patients with AMICS, we sought to evaluate in hospital and 45-day outcomes and cost, comparing patients treated with percutaneous ventricular assist device (pVAD) versus extracorporeal membrane oxygenation (ECMO). The goal of this study was to better understand clinical and economic outcomes of AMICS to help clinicians and hospitals optimize outcomes most economically for AMICS patients. METHODS A retrospective claims analysis identified patients from the full census Medicare Standard Analytic Files compiled by the Center for Medicare and Medicaid (CMS) including: Inpatient, Outpatient, Skilled Nursing Facility and Home Health files for Medicare FFS beneficiaries. Study costs were defined as the total costs incurred by providers for treating a population with AMICS. Medicare FFS beneficiaries who experienced an inpatient admission during the index period (January 1, 2015 to March 31, 2017) with a diagnosis of AMICS were eligible for study inclusion and were identified by the presence of appropriate International Classification of Diseases, Ninth and Tenth Versions (ICD-9 and ICD-10) diagnosis and procedure codes. To create a matched sample and control for any baseline differences, a 1:1 Propensity Score Matching (PSM) was performed based on criteria such as age, gender, race, geographic distribution, and 11 high-cost comorbidities (e.g., congestive HF, coronary artery disease, diabetes, etc.). Index length of stay (LOS), index costs, discharge disposition (including mortality), post-index utilization, and episode-of-care (EOC) costs were reviewed. EOC was defined as index admission for all patients plus a 45-day post index period for patients who survived the index admission. RESULTS Each cohort included 338 patients. Index in-hospital mortality rates were 53% for pVAD versus 64% for ECMO (178 vs. 217; p = .0023), and total EOC in-hospital mortality rates were 66% for pVAD versus 74% for ECMO (222 vs. 250; p = .0160). Index LOS for pVAD was 27% lower versus ECMO (12.12 vs. 16.59; p = .0006). The index LOS for patients discharged alive was 25% lower for pVAD versus ECMO (17.73 vs. 23.62; p = .0016). For patients that experienced in-hospital mortality during their index stay, pVAD had a 44% lower LOS compared to ECMO (7.08 vs. 12.66; p < .0001). Following index hospitalization, the average cost savings with additional inpatient care was 31% lower for pVAD patients ($62,188 vs. $90,087; p = NS). During the EOC, pVAD patients incurred 32% lower costs compared to ECMO patients ($117,849 vs. $172,420; <.0001). CONCLUSIONS This study of Medicare FFS patients demonstrates that hospitals utilizing pVAD for appropriately selected AMICS patients have reduced mortality rates and reduced index LOS with lower index facility costs and lower post index 45-day costs. The study results offer hospitals and clinicians an opportunity to improve clinical outcomes and reduce total EOC costs in treating patients with AMI complicated by CS.
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Affiliation(s)
- George W Vetrovec
- The VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA
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7
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Balloon Pump Counterpulsation Part II: Perioperative Hemodynamic Support and New Directions. Anesth Analg 2020; 131:792-807. [DOI: 10.1213/ane.0000000000004999] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Intraaortic Balloon Pump Counterpulsation, Part I: History, Technical Aspects, Physiologic Effects, Contraindications, Medical Applications/Outcomes. Anesth Analg 2020; 131:776-791. [DOI: 10.1213/ane.0000000000004954] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Zeliaś A, Zajdel W, Malinowski K, Geremek J, Żmudka K. Circulatory support with larger volume intra-aortic balloon pump vs. standard volume or no-balloon pump during high-risk percutaneous coronary interventions. A randomised study. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2020; 16:30-40. [PMID: 32368234 PMCID: PMC7189131 DOI: 10.5114/aic.2020.93910] [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: 01/03/2020] [Accepted: 02/17/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Percutaneous coronary intervention in high-risk patients (HRPCI) is associated with increased risk of periprocedural complications such as hypotension and shock. Mechanical circulatory support devices may the bridge patient safely throughout the procedure and are often used in this setting. AIM We assessed the outcomes of patients subjected to HRPCI and supported with intra-aortic balloon pump (IABP) of larger volume (MEGA) compared to standard volume (STRD) or no balloon support at all (CTRL). MATERIAL AND METHODS In this single-centre, open-label, randomised, controlled trial, HRPCI patients were randomly assigned to three groups: MEGA, STRD, and CTRL in a 1 : 1 : 1 scheme. Screening failure patients were assigned to the registry (REG). Composite haemodynamic endpoint (CHEP) was assessed during the procedure and major adverse cardiac even (MACE)/safety endpoints up to 1-year follow-up (FU). RESULTS A total of 36 patients were randomised (13 MEGA, 14 STRD, and 9 CTRL). The incidence of in-hospital MACE was observed in 23.1% of MEGA, 7.1% of STRD and 33.3% of CTRL (p = 0.25) patients; MACE at FU in 50.0%, 35.7%, and 55.6% (p = 0.61); major bleeding in 46.2%, 28.6%, and 22.2%, (p = 0.45); and CHEP in 15.4%, 50.0%, and 44.4%, respectively (p = 0.13). On per-treatment (PT) analysis (16 MEGA, 10 STRD, and 21 CTRL), including 11 patients from REG, in-hospital MACE was observed in 18.8% of MEGA, 10.0% of STRD, and 23.8% of CTRL (p = 0.64) patients; MACE at FU in 53.3%, 20.0%, and 57.1% (p = 0.12); major bleeding in 37.5%, 20.0%, and 33.3% (p = 0.62); and CHEP in 15.5%, 50.0%, and 52.4%, respectively (p = 0.023). CONCLUSIONS Larger volume intra-aortic balloon pump might be effective at reducing haemodynamic instability during HRPCI without a statistically significant effect on safety endpoints or MACE.
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Affiliation(s)
- Aleksander Zeliaś
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Wojciech Zajdel
- Clinic of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
| | - Krzysztof Malinowski
- Faculty of Health Sciences, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
| | - Jolanta Geremek
- Clinic of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
| | - Krzysztof Żmudka
- Clinic of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
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Lai CC, Ho CH, Chang CL, Chen CM, Chiang SR, Chao CM, Wang JJ, Cheng KC. Critical care medicine in Taiwan from 1997 to 2013 under National Health Insurance. J Thorac Dis 2018; 10:4957-4965. [PMID: 30233870 DOI: 10.21037/jtd.2018.07.131] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Monitoring of trends in the use of the intensive care unit (ICU) and the outcomes of ICU patients is essential for the assessment of the effective use of ICU. This study aims to investigate the incidence and outcome of critical care admissions in Taiwan from 1997 to 2013. Methods Patients >18 years who had ICU admission between January 1997 and December 2013 were identified from the National Health Insurance Research Database in Taiwan. The main outcomes including ICU mortality and ICU length of stay (LOS) were measured. Results A total of 3,451,157 patients with ICU admission were identified during the study period. The mean ICU LOS was 5.9±9.0 days and the overall ICU-mortality rate was 19.8%. The mean age of the patients was 65.4 years old, 58.0% were elderly (≥65 years old), 61.1% were male. Annual incidence of ICU admissions increased from 115,754 in 1997 (age-adjusted incidence: 1,130/100,000 population) to 244,820 in 2013 (incidence: 1,483/100,000 population) (P<0.0001). The admission rate was highest for patients 75-104 years old (8,074 per 100,000 population), and lowest for those 18-44 years old (298 per 100,000 population). Among ICU admission patients, the percentage of patients ≥75 years old significantly increased from 25.2% in 1997 to 38.3% in 2013 (P<0.0001). ICU LOS remained stable during the study period, but the annual mortality rate significantly decreased from 23.0% in 1997 to 16.3% in 2013. Conclusions ICU admissions significantly increased from 1997 to 2013, especially for elderly patients, in contrast, the mortality rate of ICU patients significantly declined with time. In addition, the ICU LOS did not change during the study period.
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Affiliation(s)
- Chih-Cheng Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying
| | - Chung-Han Ho
- Departments of Medical Research, Chi Mei Medical Center, Tainan.,Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy & Science, Tainan
| | - Chia-Li Chang
- Departments of Medical Research, Chi Mei Medical Center, Tainan
| | - Chin-Ming Chen
- Departments of Intensive Care Medicine, Chi Mei Medical Center, Tainan.,Chia Nan University of Pharmacy & Science, Tainan
| | - Shyh-Ren Chiang
- Chia Nan University of Pharmacy & Science, Tainan.,Departments of Internal Medicine, Chi Mei Medical Center, Tainan
| | - Chien-Ming Chao
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying
| | - Jhi-Joung Wang
- Departments of Medical Research, Chi Mei Medical Center, Tainan
| | - Kuo-Chen Cheng
- Departments of Internal Medicine, Chi Mei Medical Center, Tainan.,Department of Safety Health and Environmental Engineering, Chung Hwa University of Medical Technology, Tainan
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11
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Desai SR, Hwang NC. Advances in Left Ventricular Assist Devices and Mechanical Circulatory Support. J Cardiothorac Vasc Anesth 2018. [DOI: 10.1053/j.jvca.2018.01.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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12
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Iyengar A, Kwon OJ, Bailey KL, Ashfaq A, Abdelkarim A, Shemin RJ, Benharash P. Predictors of cardiogenic shock in cardiac surgery patients receiving intra-aortic balloon pumps. Surgery 2018; 163:1317-1323. [PMID: 29395233 DOI: 10.1016/j.surg.2017.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 10/03/2017] [Accepted: 11/22/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cardiogenic shock after cardiac surgery leads to severely increased mortality. Intra-aortic balloon pumps may be used during the preoperative period to increase coronary perfusion. The purpose of this study was to characterize predictors of postoperative cardiogenic shock in cardiac surgery patients with and without intra-aortic balloon pumps support. METHODS We performed a retrospective analysis of our institutional database of the Society of Thoracic Surgeons for patients operated between January 2008 to July 2015. Multivariable logistic regression was used to model postoperative cardiogenic shock in both the intra-aortic balloon pumps and matched control cohorts. RESULTS Overall, 4,741 cardiac surgery patients were identified during the study period, of whom 192 (4%) received a preoperative intra-aortic balloon pump. Intra-aortic balloon pumps patients had a greater prevalence of diabetes, previous cardiac surgery, congestive heart failure, and an urgent/emergent status (P < .001). Intra-aortic balloon pumps patients also had greater 30-day mortality and more postoperative cardiogenic shock (9% vs 3%, P < .001). On multivariable analysis of the matched control cohort, postoperative cardiogenic shock remained multifactorial. Among the intra-aortic balloon pumps cohort, only sex, previous percutaneous coronary intervention and preoperative arrhythmia remained significant on multivariable analysis (all P < .05). CONCLUSION Factors associated with cardiogenic shock among postcardiac surgery patients differ between those patients receiving intra-aortic balloon pumps and those who do not. Further analysis of the effects of prophylactic intra-aortic balloon pumps support is warranted. (Surgery 2017;160:XXX-XXX.).
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Affiliation(s)
- Amit Iyengar
- David Geffen School of Medicine, University of California, Los Angeles; Los Angeles, CA, USA
| | - Oh Jin Kwon
- Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Katherine L Bailey
- David Geffen School of Medicine, University of California, Los Angeles; Los Angeles, CA, USA
| | - Adeel Ashfaq
- David Geffen School of Medicine, University of California, Los Angeles; Los Angeles, CA, USA
| | - Ayman Abdelkarim
- David Geffen School of Medicine, University of California, Los Angeles; Los Angeles, CA, USA
| | - Richard J Shemin
- Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Peyman Benharash
- Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
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Nayyar M, Donovan KM, Khouzam RN. When more is not better-appropriately excluding patients from mechanical circulatory support therapy. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:9. [PMID: 29404355 DOI: 10.21037/atm.2017.09.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Mechanical circulatory support (MCS) devices are continually evolving and are providing greater hemodynamic support. This review was conducted to evaluate the prophylactic use of MCS in hemodynamically stable patients who were awaiting future coronary artery revascularization. A thorough review of published literature was conducted to evaluate for patients and clinical scenarios that are indicated for MCS, including hemodynamically stable and unstable patients awaiting revascularization. Although there have been several studies demonstrating the benefit of MCS use in hemodynamically unstable patients, there was limited trials in patients that were hemodynamically stable. The use of prophylactic MCS was limited to intra-aortic balloon pump (IABP) in "high risk" patients awaiting coronary artery bypass grafting (CABG). This review article was conducted to evaluate for possible prophylactic MCS in patients awaiting revascularization. In hemodynamically stable patients, literature is limited to the use of IABP for "high-risk" patients awaiting CABG. A thorough review of literature suggest that hemodynamically stable patients likely would not benefit from prophylactic placement MCS while awaiting revascularization although further clinical trials are needed to identify the ideal patients and clinical scenarios for the use of MCS.
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Affiliation(s)
- Mannu Nayyar
- Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Kevin Michael Donovan
- Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Rami N Khouzam
- Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
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Hou D, Yang F, Hou X. Clinical application of intra-aortic balloon counterpulsation in high-risk patients undergoing cardiac surgery. Perfusion 2017; 33:178-184. [PMID: 28975854 DOI: 10.1177/0267659117734630] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The intra-aortic balloon pump (IABP) has been the most commonly used mechanical circulatory support device for nearly five decades. In theory, the IABP can increase the blood and oxygen supply of the coronary artery by increasing the diastolic pressure in the aortic root when the balloon is inflated and reduce left ventricular afterload by rapidly deflating the balloon during the systolic phase. Therefore, some researchers put forward the idea of preoperative prophylactic use of an IABP, which has been frequently performed in high-risk patients undergoing elective percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG). Previous studies have suggested preoperative IABP has a controversial effect on patients undergoing revascularization; the role of preoperative IABP insertion in those patients undergoing CABG alone remains uncertain. This review will give further insight into routine IABP use by presenting the basic principles and discussing current evidence.
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Affiliation(s)
- Dengbang Hou
- Center for Cardiac Intensive Care, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Feng Yang
- Center for Cardiac Intensive Care, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaotong Hou
- Center for Cardiac Intensive Care, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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15
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Hira RS, Nichol G. Management of Refractory Ventricular Fibrillation. JACC Basic Transl Sci 2017; 2:254-257. [PMID: 30062147 PMCID: PMC6034480 DOI: 10.1016/j.jacbts.2017.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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16
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Jiang X, Zhu Z, Ye M, Yan Y, Zheng J, Dai Q, Wen L, Wang H, Lou S, Ma H, Ma P, Li Y, Yang T, Zuo S, Tian Y. Clinical application of intra-aortic balloon pump in patients with cardiogenic shock during the perioperative period of cardiac surgery. Exp Ther Med 2017; 13:1741-1748. [PMID: 28565761 PMCID: PMC5443233 DOI: 10.3892/etm.2017.4177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 12/20/2016] [Indexed: 02/02/2023] Open
Abstract
Intra-aortic balloon pumps (IABP) have saved many patients with cardiogenic shock during the perioperative period of cardiac surgery. However, the ideal insertion timing is controversial. In the present study, we aimed to optimize the insertion timing, in order to increase the survival rate of the patients. A total of 197 patients with cardiogenic shock during the perioperative period of cardiac surgery and implemented IABP from January 2011 to October 2015 were selected for the study. Patients were divided into five groups on the basis of application timing of IABP: 0–60, 61–120, 121–180, 181–240 and >240 min. The 30-day mortality, application rate of continuous renal replacement therapy (CRRT), duration of mechanical ventilation, duration of hospital stay and hospitalization charges were analyzed in the above groups. The risk factors related to mortality and the occurrence of IABP complications were also analyzed. The mortality in the 0–60, 61–120, 121–180, 181–240 and >240 min groups were 42.17, 36.6, 77.3, 72.7 and 79.3%, respectively. Earlier IABP insertion resulted in less patients receiving CRRT from acute renal failure and less daily hospitalization charges. However, the IABP application timing had no effect on indexes such as hospitalization duration, duration of mechanical ventilation and total hospitalization charges. Multifactor logistic regression analysis indicated that the independent risk factors of death in patients with cardiogenic shock during cardiac surgery were related to IABP support timing and vasoactive-inotropic score (VIS) before balloon insertion. In the first 120 min of cardiogenic shock during the perioperative period of cardiac surgery, IABP application decreased 30-day mortality. Mortality was related with VIS score of patients, which can be used to predict the prognosis of patients with cardiogenic shock.
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Affiliation(s)
- Xuesong Jiang
- Department of Critical Care Medicine, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Zhitao Zhu
- Department of Cardiovascular Surgery, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Ming Ye
- Department of Critical Care Medicine, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Yan Yan
- Department of Pharmacology, Harbin Medical University, The State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Harbin, Heilongjiang 150086, P.R. China
| | - Junbo Zheng
- Department of Critical Care Medicine, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Qingqing Dai
- Department of Critical Care Medicine, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Lianghe Wen
- Department of Critical Care Medicine, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Huaiquan Wang
- Department of Critical Care Medicine, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Shaofei Lou
- Department of Critical Care Medicine, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Hongmei Ma
- Department of Critical Care Medicine, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Pingwei Ma
- Department of Critical Care Medicine, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Yunlong Li
- Department of Critical Care Medicine, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Tuoyun Yang
- Department of Critical Care Medicine, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Shu Zuo
- Department of Critical Care Medicine, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Ye Tian
- Department of Cardiology, The First Affiliated Hospital, Cardiovascular Institute, Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China.,Department of Pathophysiology and The Key Laboratory of Cardiovascular Pathophysiology, Harbin Medical University, The Key Laboratory of Cardiovascular Research of Harbin Medical University, Ministry of Education, Harbin, Heilongjiang 150081, P.R. China.,Heilongjiang Academy of Medical Sciences, Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
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MacKay EJ, Patel PA, Gutsche JT, Weiss SJ, Augoustides JG. Contemporary Clinical Niche for Intra-Aortic Balloon Counterpulsation in Perioperative Cardiovascular Practice: An Evidence-Based Review for the Cardiovascular Anesthesiologist. J Cardiothorac Vasc Anesth 2017; 31:309-320. [DOI: 10.1053/j.jvca.2016.07.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Indexed: 01/10/2023]
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Yuan L, Nie SP. Efficacy of Intra-aortic Balloon Pump before versus after Primary Percutaneous Coronary Intervention in Patients with Cardiogenic Shock from ST-elevation Myocardial Infarction. Chin Med J (Engl) 2016; 129:1400-5. [PMID: 27270533 PMCID: PMC4910361 DOI: 10.4103/0366-6999.183428] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Previous studies showed that patients with cardiogenic shock (CS) from ST-elevation acute myocardial infarction (STEMI) supported by intra-aortic balloon pump (IABP) before primary percutaneous coronary intervention (PCI) decreased the risk of in-hospital mortality than patients who received IABP after PCI. However, little evidence is available on the optimal order of IABP insertion and primary PCI. The aim of this study was to investigate the impact of the sequence of IABP support and PCI and its association with major adverse cardiac and cerebrovascular events (MACCEs). METHODS Data were obtained from 218 consecutive patients with CS due to STEMI in Beijing Anzhen Hospital between 2008 and 2014, who were treated with IABP and PCI. The patients were divided into two groups: Group A in whom IABP received before PCI (n = 106) and Group B in whom IABP received after PCI (n = 112). We evaluated the myocardial perfusion using myocardial blush grade and resolution of ST-segment elevation. The primary endpoint was 12-month risk of MACCE. RESULTS Most baseline characteristics were similar in patients between the two groups. However, patients received IABP before PCI were associated with a delay of door-to-balloon time (DBT) and higher troponin I level (P < 0.05). However, myocardial perfusion was significantly improved in patients treated with IABP before PCI (P < 0.05). Overall, IABP support before PCI was not associated with significantly lower risk of MACCE (P > 0.05). In addition, risk of all-cause mortality, bleeding, and acute kidney injury (AKI) was similar between two groups (P > 0.05). Multivariate analysis showed that DBT (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.1-4.8, P = 0.04), IABP support after PCI (OR 5.7, 95% CI 2.7-8.4, P = 0.01), and AKI (OR 7.4, 95% CI 4.9-10.8, P = 0.01) were the independent predictors of mortality at 12-month follow-up. CONCLUSIONS Early IABP insertion before primary PCI is associated with improved myocardial perfusion although DBT increases. IABP support before PCI does not confer a 12-month clinical benefit when used for STEMI with CS.
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Affiliation(s)
- Lin Yuan
- Emergency Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
- Emergency Critical Care Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
| | - Shao-Ping Nie
- Emergency Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
- Emergency Critical Care Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China
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