Hemodynamic assessment and risk classification for successful weaning of Impella in patients with cardiogenic shock

• Published in: Artificial organs Vol. 46; no. 7; pp. 1358 - 1368
• Main Authors: Ikeda, Yuki, Ishii, Shunsuke, Maemura, Kenji, Oki, Takumi, Yazaki, Mayu, Fujita, Teppei, Iida, Yuichiro, Kinoshita, Daisuke, Sato, Nobuhiro, Ako, Junya
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.07.2022
• Subjects: Catheters; Classification; Heart-Assist Devices - adverse effects; Hemodynamics; Humans; mechanical circulatory support; Medical instruments; outcome; Patients; Pulmonary arteries; Pulmonary artery; pulmonary artery catheterization; Reintroduction; Retrospective Studies; Shock, Cardiogenic - etiology; Shock, Cardiogenic - surgery; Survival; Treatment Outcome; Veins & arteries; Weaning; mechanical circulatory support; pulmonary artery catheterization; hemodynamics; outcome; weaning
• ISSN: 0160-564X; 1525-1594
• DOI: 10.1111/aor.14197

Background Clinical predictors for successful weaning of patients from Impella heart pump have not been clarified. We aimed to elucidate the relationship between pulmonary artery catheter (PAC) parameters at the time of Impella weaning and subsequent outcomes. Methods We enrolled consecutive patients who had received Impella for cardiogenic shock. PAC data were collected immediately before Impella weaning. Patients were classified as non‐survivors if they died or required any mechanical circulatory support reintroduction within 30 days of weaning. Results Of 81 patients enrolled, 61 underwent Impella weaning. Of these, 16 were non‐survivors. Predictive indicators of non‐survival were high pulmonary artery wedge pressure (PAWP; hazard ratio [HR] per 5 mm Hg 1.97, 95% CI 1.35–2.80; p < 0.001), high mean pulmonary artery pressure (MPAP; HR per 5 mm Hg 1.90, 1.38–2.58; p < 0.001), and low cardiac power output (CPO; HR per 0.1 Watts 0.71, 0.52–0.92; p = 0.006). Cutoff values of PAWP 20 mm Hg, MPAP 22 mm Hg, and CPO 0.59 Watts showed strong associations with 30‐day non‐survival risk (low risk 8% in patients with low PAWP and high CPO or 4% in patients with low MPAP and high CPO; high risk 100% in patients with high PAWP and low CPO or 82% in patients with high MPAP and low CPO). Conclusions PAWP or MPAP higher than the cutoff with CPO below the cutoff at Impella weaning were associated with worse outcomes. We proposed a risk classification model for successful Impella weaning using PAC. This study proposed a risk classification model for successful Impella weaning. Hemodynamic assessment using pulmonary artery catheter allowed us to clearly stratify the risk of 30‐day mortality or reintroduction of mechanical circulatory support after Impella weaning.