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| Temporary acute mechanical circulatory support for acute circulatory collapse: experience with 266 patients | |
Kristopher B. Deatrick, Amit K. Mathur, Ann Schumar, Robert H. Bartlett, Francis D. Pagani, Jonathan W. Haft; Cardiac Surgery, The University of Michigan, Ann Arbor, MI
Methods: We systematically reviewed the records of patients 16 years of age and older who received temporary mechanical support due to acute circulatory collapse. Three modes of support were used: venoarterial extracorporeal membrane oxygenation (ECMO), ABIOMED ventricular assist device (VAD) systems, or the TandemHeart percutaneous VAD. Circulatory support was used for circulatory collapse due one of the following: acute myocardial infarction (AMI) n=61 (23%), post-cardiotomy failure n=34 (13%), pulmonary embolism (PE) n =13 (5%), cardiomyopathy (CM) n=77 (29%), sepsis n=22 (8%), other acute heart failure n=28 (11%), or heart or lung transplant graft dysfunction (GD) n=17 (6%). Mortality was confirmed using the Social Security Death Index. Survival was estimated using the Kaplan-Meier method. Risk-adjusted in-hospital mortality was determined using Cox proportional-hazards models. Results: From 1997-2008, 278 patients at our center have received temporary circulatory support; 266 patients had sufficient data available for analysis. Mean age of patients was 47.5 +/- 14.1 years. 60% (n=159) of patients were male. Average duration on acutely placed support was 5.2 ±5.6 days. 57% (n=154) of patients were successfully weaned. Survival to discharge was 40% (n=113). Of patients who survived to discharge, median survival was 235 days. 26% of patients (n=68) received a long term VAD, and 18% (n=47) underwent heart transplantation. Device-specific survival is demonstrated in figure 1. The AMI indication was independently associated with increased in-hospital mortality (HR 2.56, 95% CI (1.01-6.50)). Male gender (HR 0.70 95% CI (0.48-0.99)), support greater than 5 days (HR 0.62 95%CI(0.43-0.88)), and receiving a long-term VAD (HR 0.55 95%CI(0.34-0.89)) were independently associated with lower mortality. Conclusion: Reasonable survival can be expected for patients requiring temporary circulatory support with a variety of devices. Acute MI was an independent predictor of in-hospital mortality. Multi-center data is needed to better understand predictors of mortality following acute circulatory support. 
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