Author + information
- Mir Basir1,
- Theodore Schreiber2,
- Simon Dixon3,
- Khaldoon Alaswad4,
- Kiritkumar Patel5,
- Steven Almany6,
- Akshay Khandelwal7,
- Augustine George8,
- Michael Ashbrook3,
- Nimrod Blank2,
- Nishtha Sareen9 and
- William O'Neill4
- 1Henry Ford Hospital, Canton, Michigan, United States
- 2Detroit Medical Center, Detroit, Michigan, United States
- 3Beaumont Hospital, Royal Oak, Michigan, United States
- 4Henry Ford Hospital, Detroit, Michigan, United States
- 5Saint Joseph Mercy Oakland, Bloomfield hills, Michigan, United States
- 6Beaumont Health, Royal oak, Michigan, United States
- 7Henry Ford Hospital, Northville, Michigan, United States
- 8Saint Joseph Mercy Oakland, Auburn Hills, Michigan, United States
- 9St Joseph Mercy Oakland Hospital, Birmingham, Michigan, United States
The Detroit Cardiogenic Shock Initiative is a single-arm, multicenter study to assess the feasibility of early mechanical circulatory support (MCS) in patients who present with acute myocardial infarction complicated by cardiogenic shock (AMICS) who undergo percutaneous coronary intervention.
Between July 2016 and February 2017, 5 metro Detroit sites participated in the study. The centers agreed to treat all patients with AMICS using a mutually agreed-upon protocol emphasizing invasive hemodynamic monitoring and rapid initiation of MCS. Inclusion and exclusion criteria mimicked those from the ‘SHOCK’ trial with an additional exclusion criteria being use of intra-aortic balloon pump counter pulsation prior to MCS.
A total of 40 consecutive patients were included. Patients had an average age of 65±14 years and 70% were male. 60% of patients were admitted to the hospital in cardiogenic shock. Prior to receiving MCS, 92 % of patients were on vasopressors or inotropes. 15% of patients had a witnessed out of hospital cardiac arrest, 28% of patients had an in-hospital cardiac arrest, and 18% were under active cardiopulmonary resuscitation while MCS was being implanted. Right heart catheterization and hemodynamic monitoring was performed in 83% of patients. Door to support times averaged 85 +/- 59 minutes. 69% of patients were able to reduce the levels of inotropes and vasopressors within the first 24-hours of MCS initiation. Pre-MCS cardiac power output (CPO) was 0.57 W and post-MCS CPO was 0.95 W, a 67% increase (p<0.001). Survival to explant for the entire cohort was 85% a significant improvement from historical controls (85% vs 51% p<0.001) and survival to discharge was 75%.
Centers who systemically implement the delivery of early MCS can achieve rapid door to support times and can improve survival in patients who present with AMICS. Larger national studies will be needed to further validate this pilot feasibility study.
CORONARY: Hemodynamic Support and Cardiogenic Shock