ArticleJournal of the American Heart Association2025
Phase-Specific Hemodynamic Criteria and Outcomes in Patients With Cardiogenic Shock Receiving Percutaneous Ventricular Assist Devices.
Article in Journal of the American Heart Association, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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Who cites it
2 citing papers in PubMed.
- UNLOADERS-PVAD Weaning Score: predicting post-weaning adverse events in cardiogenic shock patients supported by microaxial flow pump.Journal of intensive care · 2025Article
- SCAI Door to Lactate Clearance (SCAI DLC) Cardiogenic Shock Initiative: Definition, Hypothesis, and Call to Action.Journal of the Society for Cardiovascular Angiography & Interventions · 2025Article
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundStandardized protocols with optimal hemodynamic targets for percutaneous ventricular assist device (PVAD) management remain undefined. We aimed to evaluate the proportion of phase-specific hemodynamic criteria achieved during PVAD support and their association with outcomes in patients with cardiogenic shock.
methodsThis multicenter retrospective study enrolled patients with cardiogenic shock requiring PVAD (Impella). Patients were evaluated at 24 hours post-PVAD, venoarterial extracorporeal membrane oxygenation weaning, and PVAD weaning. Hemodynamic criteria consisted of key targets, including mean arterial pressure ≥60 mm Hg, lactate <2.0 mmol/L, right atrial pressure <15 mm Hg, pulmonary artery wedge pressure <20 mm Hg, pulmonary artery pulsatility index ≥1.0, and cardiac power output ≥0.6 W. The primary outcome was a composite of 30-day all-cause mortality and unplanned mechanical circulatory support reintroduction.
resultsA total of 501 patients were enrolled: 206 (41%) with PVAD alone and 295 (59%) with PVAD and venoarterial extracorporeal membrane oxygenation. The majority of patients were supported with Impella CP (406, 81%). Fulfillment of criteria was observed in 37%, 52%, and 45% at 24 hours post-PVAD, venoarterial extracorporeal membrane oxygenation weaning, and PVAD weaning, respectively. Patients with unfulfilled criteria at each evaluation point were at high risk for the primary outcome (hazard ratio, 3.2 [95% CI, 2.1-4.8]; hazard ratio, 2.1 [1.2-3.7]; and hazard ratio, 2.0 [95% CI, 1.1-3.6]). Hemodynamic criteria achievement consistently stratified the risk of the primary outcome across different subgroups, including shock cause, shock stage, and concomitant use of venoarterial extracorporeal membrane oxygenation.
conclusionsPhase-specific hemodynamic criteria are often unmet and are associated with significantly higher risks of short-term fatal events.
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