Temporal Hemodynamic Patterns in Cardiogenic Shock Treated With Isolated Percutaneous Ventricular Assist Device and Combined Therapy With Venoarterial Extracorporeal Membrane Oxygenation.

BACKGROUND

This study aimed to describe hemodynamic trends in patients with cardiogenic shock who received either isolated microaxial flow pump (mAFP) support or additional mAFP on venoarterial extracorporeal membrane oxygenation support (ie, VA-ECMO + mAFP). Trends also were analyzed by hospital survival in each group.

METHODS

Using mixed-effect models, we analyzed hemodynamic indices from pre-, post-, and 24 hours after mAFP installation to immediately before device explantation in patients from the UNLOADERS-PVAD (UNLoading and heart recOvery with ADvanced mEchanical ciRculatory Support: optimal management of Percutaneous Ventricular Assist Device) Registry, a Japanese multicenter registry of patients with cardiogenic shock receiving mAFP.

RESULTS

Hemodynamic indices from 409 patients (mean age 67 years, 75% male; 206 with isolated mAFP and 203 with VA-ECMO + mAFP) were analyzed. From immediately before mAFP installation to immediately before mAFP explantation, the mAFP group achieved an 11.8-mm Hg decrease in pulmonary artery wedge pressure, a 5.8-mm Hg decrease in right atrial pressure, and a 1.32 L/min increase in cardiac output (COPAC). Similarly, the ECMO + mAFP group showed a 2.8 L/min and 0.4 W increase in COPAC and cardiac power output, respectively. Changing patterns of hemodynamic indices were comparable between survivors and nonsurvivors with isolated mAFP support. In the ECMO + mAFP group, survivors demonstrated additional increases in COPAC, aortic pulsatility index, and myocardial performance score as well as reductions in pulmonary artery wedge pressure and diastolic pulmonary arterial pressure after VA-ECMO explantation.

CONCLUSIONS

Patients with mAFP for cardiogenic shock exhibited progressive decreases in atrial pressures and increases in cardiac output, with distinct patterns in survivors receiving mAFP in addition to VA-ECMO. Hemodynamic monitoring may help determine the extent of cardiac recovery during combination therapy.