Author + information
- Angelika Uwarow1,
- Sandra Büter1,
- Julian Wiora1,
- Jean Haurand1,
- Christian Jung1,
- Ralf Westenfeld2 and
- Patrick Horn1
In patients with cardiogenic shock, pneumonia due to pulmonary congestion and subsequent septic shock is associated with high mortality. In this setting, reduced cardiac index, elevated filling pressure, and acute exacerbation of mitral regurgitation are the main driving factors underlying pulmonary congestion. The impact of left ventricular unloading by percutaneous the left ventricular assist device (pVAD), Impella, on pulmonary congestion in patients with cardiogenic shock has not been investigated.
In this retrospective study we assessed pulmonary congestion in patients with cardiogenic shock who received the Impella® pVAD (n=30) compared to those who received intra-aortic balloon pump (IABP) support (n=31). Pulmonary congestion was the primary endpoint and was assessed by calculating characteristic findings on the chest x-ray using the Halperin-score. Scores range from 0 to a maximum of 390 points and were assessed in both groups before (pre) and longitudinally (24h [d1], 72h [d3]) during support. The rate of pneumonia was assessed as a secondary endpoint.
The groups (Impella vs. IABP) did not differ in terms of age (65±2.6 vs. 67.±2.2 years, p=0.4), SOFA Score (8.9±2.8 vs. 8.7±3.1, p=0.9), Apache Score 24.3±1.3 vs. 24.1±1.5, p=0.9) or basal serum lactate levels (4.5±0.5 vs. 5.0±0.8 mg/dl, p=0.57). Total fluid balance was calculated as positive during support and did not differ in both groups: +2.4±0.6 l vs. +1.8±0.4 l at day 1 (p=0.57), +1.3±0.7 l vs +0.6±0.4 l at day 2 (p=0.86) and +0.2±0.7 l vs. +0.3±0.9 l at day 3 (p=0.80). Pulmonary congestion as indicated with the Halperin score decreased post-implantation in patients with Impella® support (pre 224±14, d1 178±11, d3 169±12, p=<0.01), but it did not decrease in patients with IABP support (pre 212±14, d1 214±10, d3 206±9, p=0.42). The incidence of pneumonia did not differ between Impella® group (57%, 17/30) and IABP group (74%, 23/31) (p=0.18).
Left ventricular unloading by Impella® support reduces pulmonary congestion in patients with cardiogenic shock despite performed positive fluid balance. Therefore, Impella® support may facilitate treatment of congestive pneumonia in patients with cardiogenic shock although prospective trials in larger patient cohorts are required.
CORONARY: Hemodynamic Support and Cardiogenic Shock