Predictors of Mortality and Associated Lactate Trends in Cardiogenic Shock Patients Treated with Impella? Placement - A Single Center Experience

摘要

Background : The Impella? devices have increasingly become a desired treatment option for cardiogenic shock (CS) as demonstrated by studies analyzing real-world use of hemodynamic support devices. However, data regarding outcomes after Impella? device implant and optimal timing of device placement remains scarce. This study investigates prognostic factors including serial lactate levels in CS patients treated with Impella?. Methods : This retrospective study reviewed 76 consecutive patients diagnosed with CS supported with Impella? at a large, tertiary-care university medical center. Clinical variables and outcomes examined include co-morbidities, pre- and post-procedural lactate levels, and mortality. Results : Of the 76 patients requiring an Impella?, 70% of patients survived to hospital discharge. Those who died post-device implant had a higher prevalence of hyperlipidemia (HLD), chronic kidney disease (CKD), and more likely to require multiple (1) vasopressors. The mean pre-procedural lactate levels were significantly higher (5.86 /- 5.11 vs 2.16 /- 1.50, p = 0.01) in the population who died, along with the change in lactate levels (1.90 /- 2.56 vs -0.40 /- 1.73, p=0.04). Those who died within 24 hours of implant showed a trend toward higher mean pre-procedural lactate levels (8.46 /- 6.00 vs 3.86 /- 3.31, p = 0.12). Conclusions : Higher pre-procedural lactate levels, HLD, CKD, and increased vasopressor requirement were predictive of increased mortality in CS patients post-Impella? placement, especially within 24 hours of implant. Through serial lactate measurements, we demonstrated favorable outcomes in patients with early stabilization or greater lowering of post-procedural lactate levels suggestive of improved end organ perfusion.