Letter by Maini Regarding Article, “Percutaneous Left-Ventricular Support With the Impella-2.5-Assist Device in Acute Cardiogenic Shock: Results of the Impella-EUROSHOCK-Registry”

HomeCirculation: Heart FailureVol. 6, No. 4Letter by Maini Regarding Article, “Percutaneous Left-Ventricular Support With the Impella-2.5-Assist Device in Acute Cardiogenic Shock: Results of the Impella-EUROSHOCK-Registry” Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBLetter by Maini Regarding Article, “Percutaneous Left-Ventricular Support With the Impella-2.5-Assist Device in Acute Cardiogenic Shock: Results of the Impella-EUROSHOCK-Registry” Brijeshwar Maini, MD Brijeshwar MainiBrijeshwar Maini PinnacleHealth Cardiovascular InstituteWormleysburg, PA Search for more papers by this author Originally published1 Jul 2013https://doi.org/10.1161/CIRCHEARTFAILURE.113.000322Circulation: Heart Failure. 2013;6:e55To the Editor:In their article, Lauten et al1 describe very eloquently the continued dismal prognosis of patients presenting with cardiogenic shock,2 despite tremendous strides that have been made in the field of cardiovascular medicine.The patients included in the registry met the diagnosis of cardiogenic shock as per the standard definitions from the SHOCK trial and underwent standard of care treatment, including high-dose vasopressors and intra-aortic balloon pump support if considered necessary, and the decision to institute Impella LP 2.5 support was only made when the patients were refractory and unresponsive to the above therapy. Also, it is important to note that a large proportion of patients were resuscitated from cardiac arrest and had lactic acidosis reflecting severe organ hypoperfusion at the time of initiation of cardiac support with the Impella LP 2.5 device.It is, therefore, understandable that the results of the EUROSHOCK registry were dismal.As we all know the use of percutaneous ventricular assist devices is on the rise not necessarily because of the availability of randomized control data but more so from registry experience. It is, therefore, very important to understand this disappointing data and how to apply it in your own practice when faced with a similarly sick patient.It has been shown that earlier institution of support in patients with refractory cardiogenic shock results in a markedly improved survival (77% versus 44%, respectively; P=0.01).3 The results from the EUROSHOCK registry probably reflect the patients who were treated with vasopressors and intra-aortic balloon pump support initially and, therefore, had a more dismal outcome.As reported, there was an improvement in the lactic acid levels in patients when they were placed on Impella LP 2.5 support. One would, therefore, surmise that if these patients had been placed on support initially with the Impella device, their outcomes might have been more positive.Time is of the essence in this sick patient population. Earlier institution of support with the 2.5-L device and rapid escalation of support to the 4- or 5-L devices should be considered before the patient develops severe hypoperfusion. Consideration should also be given to support with an extracorporeal membrane oxygenator and finally to surgical ventricular assist devices, depending on the clinical situation of the patient.Most importantly, a multidisciplinary approach, including interventional cardiologists, heart failure cardiologists, and cardiothoracic surgeons, be used to salvage this dismal situation.DisclosuresDr Maini is on the Speaker’s Bureau for AbioMed.References1. Lauten A, Engström AE, Jung C, Empen K, Erne P, Cook S, Windecker S, Bergmann MW, Klingenberg R, Lüscher TF, Haude M, Rulands D, Butter C, Ullman B, Hellgren L, Modena MG, Pedrazzini G, Henriques JP, Figulla HR, Ferrari M. Percutaneous left-ventricular support with the Impella-2.5-assist device in acute cardiogenic shock: results of the Impella-EUROSHOCK-registry.Circ Heart Fail. 2013; 6:23–30.LinkGoogle Scholar2. Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, Richardt G, Hennersdorf M, Empen K, Fuernau G, Desch S, Eitel I, Hambrecht R, Fuhrmann J, Böhm M, Ebelt H, Schneider S, Schuler G, Werdan K; IABP-SHOCK II Trial Investigators. Intraaortic balloon support for myocardial infarction with cardiogenic shock.N Engl J Med. 2012; 367:1287–1296.CrossrefMedlineGoogle Scholar3. Maini B, Naidu S, Schreiber T, Dixon S, O’Neill W. Early Hemodynamic Support with Impella 2.5 Improves Survival in Refractory Cardiogenic Shock After Acute Myocardial Infarction.J Am Coll Cardiol. 2011; 58:B128–B128.CrossrefGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Iancu A, Dregoesc M, Solomoneanu A and Benedek T (2019) A Long-Forgotten Tale: The Management of Cardiogenic Shock in Acute Myocardial Infarction, Journal Of Cardiovascular Emergencies, 10.2478/jce-2018-0023, 4:4, (170-177), Online publication date: 1-Dec-2018., Online publication date: 1-Dec-2018. July 2013Vol 6, Issue 4 Advertisement Article InformationMetrics © 2013 American Heart Association, Inc.https://doi.org/10.1161/CIRCHEARTFAILURE.113.000322PMID: 23861510 Originally publishedJuly 1, 2013 PDF download Advertisement SubjectsTreatment