Ventricular assist device association in improving outcomes in patients resuscitated from out of hospital cardiac arrest
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There has been continued debate on the efficacy of ventricular assist devices (VAD) on improving survival outcomes in post cardiac arrest patients.
The objective of this study is to assess whether the use of VAD is associated with improved survival outcome in patients resuscitated from out-of-hospital cardiac arrest in Michigan.
We matched cardiac arrest cases from 2014-2017 in the Michigan CARES Registry (CARES) and the Michigan Inpatient Database (MIDB) using probabilistic linkage.VAD are defined as either IABP or Impella device identified using ICD-9 or 10 procedure codes. Multilevel, multivariable regression analyses were employed to evaluate the impact of device use on survival, adjusting for variables normally predictive of cardiac arrest survival (age, location, witnessed, shockable rhythm).
A total of 3,790 CARES cases were matched with MIDB of which 183 (4.8%) received IABP, 50 (1.3%) Impella, and 1,131 (29.8%) survived to discharge. VAD use was associated with improved survival to discharge (OR=2.07, 95% CI 1.55, 2.77). IABP were used more frequently and associated with an improved outcome (OR=2.16, 95%CI 1.59, 2.93) compared to Impella (OR=1.72, 95% CI 0.96, 3.06). In a multivariable model, however, VAD was no longer associated with an improved outcome (aOR =0.95, 95% CI 0.69, 1.31). In the subset of patients with cardiogenic shock (n=725) we identified an improved survival with VAD (OR= 1.84 95% CI 1.24, 2.73). IABP use was more frequent and associated with an improved outcome (OR=1.98, 95% CI 1.32, 2.98). After adjusting for patient characteristics, VAD increased odds of improved outcome by 14% but was not statistically significant (aOR = 1.14, 95% CI 0.74, 1.77 ).
Although limited by low frequency of use, VAD or IABP alone was associated with improved outcomes for post arrest care. However, in a multivariable analysis, VAD use was not associated with an independent improvement in post arrest survival.
resuscitation, VAD, ventricular assist device
Tram J, Pressman A, Chen NW, Berger D, Miller J, Welch R et al. [Swor R] Ventricular assist device association in improving outcomes in patients resuscitated from out of hospital cardiac arrest. Poster presented at: Oakland University William Beaumont School of Medicine Embark Capstone Colloquium; 2022 May 2; Rochester Hills, MI.
The Embark Capstone Colloquium at the Oakland University William Beaumont School of Medicine, Rochester Hills, MI, May 2, 2022.