Cardiothoracic & vascular anaesthesia
Implementation of a standardized Impella-specific management pathway in cardiogenic shock
Main finding · In-hospital deathResult — go to the resultHazard ratio 0.51 95% CI 0.32–0.84Authors' conclusion
SIM was progressively implemented across the catheterization laboratory and ICU, accompanied by measurable changes in care processes and lower rates of major bleeding and in-hospital death.
Study context
- Population
- Consecutive patients with cardiogenic shock treated with Impella
- Participants
- 190 consecutive patients
- Exposure
- SIM vs Before
- SIMn = 102
- Beforen = 88reference
- Outcome
- All-cause in-hospital mortality
Methodological detailssingle-centre, overlap-weighted cause-specific Cox models
- Single-centre
- Overlap-weighted cause-specific Cox models
Main finding
In-hospital death
Hazard ratio
0.51
95% CI 0.32–0.84
P = 0.009
By group
As reported in the abstract
Observational data: associations, not effects.
Secondary outcomes
Impella-related BARC type 3 or 5 bleeding (key secondary endpoint)
- Impella-related type 3 or 5 bleeding, before implementation vs after SIM introduction, respectively
- 30.7 and 12.7%
- After vs before SIM introduction, HR
- 0.33 (0.16-0.67); P = 0.002 (95% CI)
- Overlap-weighted cause-specific Cox model
Pre-PCI Impella use in acute MI
- Increased after SIM introduction
- 36.2 to 76.2%
16-Fr sheath use
- Increased after SIM introduction
- 0 to 80.2%
Detected hemolysis; time outside MAP and central venous pressure target ranges
- Detected hemolysis increased progressively; time outside MAP and central venous pressure targets decreased
In-hospital mortality by SCAI shock stage, arrest or ECPELLA status (subgroup)
- No significant interaction
Safety
BARC type 5 bleeding, acute limb ischemia, stroke
- Did not differ significantly
Original publication
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