title: Biventricular unloading in patients with refractory cardiogenic shock.
abstract: BACKGROUND
  Cardiogenic shock remains a clinical challenge with high mortality rate. Mechanical circulatory support (MCS) devices have become an integral component of the therapeutic armamentarium expanding the treatment options for refractory cardiogenic shock (RCS).
  
  
  METHODS
  We included all consecutive patients with biventricular unloading with Impella-2.5 and VA-ECMO admitted for RCS between October 2013 and March 2015. Outcome data included survival to discharge, bridging to VAD and 28-day mortality.
  
  
  RESULTS
  A total of 17 patients were included. Mean age was 63.3±10.5 and 15 (88%) patients were male. RCS resulted from acute myocardial infarction in 14 (82%), acute myocarditis in 1 (6%) dilated cardiomyopathy in 2 (12%) patients. Mean SAPS II and SOFA score on admission was 74.7±16.86 and 11.16±1.79, respectively. Vasopressor doses and lactate levels were significantly decreased within 72h on biventricular support (p=0.025 for norepinephrine and p=0.005 for lactate). Nine (53%) patients died while on support. Of the remaining 8 patients, 5 (29%) patients were weaned successfully and discharged in cardiac rehabilitation and 3 (18%) patients were successfully bridged to VAD. All 5 patients who were discharged to rehabilitation survived at day 28 after discharge, while 1 of 3 VAD patients died after VAD implantation, corresponding to an overall 28-day survival rate of 41%.
  
  
  CONCLUSIONS
  Biventricular support with Impella-2.5 and VA-ECMO in patients with RCS is feasible and led to significant hemodynamic improvement and reduction of lactate levels. Despite high severity scores, ICU- and 28-day mortality rates were better than predicted.
authors: Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, Germany. Electronic address: konstantinos.karatolios@med.uni-marburg.de.
authors: Konstantinos
authors: K
authors: Karatolios
authors: Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, Germany; Hippokration Hospital, 1st Cardiology Unit, Kapodistrian University of Athens, Greece.
authors: Georgios
authors: G
authors: Chatzis
authors: Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, Germany.
authors: Birgit
authors: B
authors: Markus
authors: Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, Germany.
authors: Ulrich
authors: U
authors: Luesebrink
authors: Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, Germany.
authors: Anette
authors: A
authors: Richter
authors: Department of Cardiology, Angiology and Intensive Care, Philipps University Marburg, Germany.
authors: Bernhard
authors: B
authors: Schieffer
mesh_terms: D000368:Aged; D001243:Assisted Circulation / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D006353:Heart-Assist Devices / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D015996:Survival Rate / Q000639:trends; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*
keywords: Biventricular support; Impella; Mechanical circulatory support; Refractory cardiogenic shock; VA-ECMO; VAD