Predictors of IABP Failure Flashcards
ADHF
Acute Decompensating Heart Failure
How is ADHF usually treated?
Dieresis, inotropes and sometimes IABP, Impella or ECMO
What did this study look at?
Hemodynamic effects of treating cardiogenic shock complicating non-AMI ADHF.
Who did the study look at?
Known or newly diagnosed cardiomyopathy who required IABP for treatment of CS.
How did they define cardiogenic shock
Systolic BP < 90 for at least 30 minutes with evidence of poor end organ perfusion or need for inotropic support.
What monitoring devices were used?
Swan, SV02, Echo , LVCPI
RVCPI equation
CI x Mean PA presssure / 451.
How many patients were in the final cohort?
74 (2010-2105) 400 were excluded
Of the 74 patients ____ survived to Hospital discharge after successful IABP wean.
15 (20%)
Of the 74 patients ____ underwent successful bridge to LVAD or OHT
38 ( 51%) (33 LVAD, 5 OHT)
____ patients suffered an adverse event (death on IABP support or urgent escalation)
21 (28%)
____ died with IABP support prior to any possible intervention
18
______ required urgent escalation of MCS
3 (1 ECMO, 2 Impella)
What percent of patients had ischemic cardiomyopathy vs non-Ischemic cardiomyopathy?
26% vs 74%
By 12 hours, there was a significant decrease in ______ and ______ and significant increase in _____.
HR & SVR
CI
there was also a slight but significant decrease in ____ ___ and un-augmented ______ blood pressures
Systemic systolic
Diastolic
As expected with IABP support, this was accompanied by a slight trend towards increased ____ _____
Augmented MAP
In concordance, there was a significant improvement in both right and left sided ____ ____ & ____ ____
Filling pressures and pulmonary pressures.
Despite hemodynamic improvement, _____ % of this cohort suffered an adverse event
28%
When did the adverse event group see a decline in CI?
24-48 hours after IABP placement
What did they find?
That history of ischemic cardiomyopathy (ICM) and low baseline LVCPI were the most power predictors of adverse in-hospital events.
What did LVCPI strongly predict?
Survival free of adverse events over the 28-days post IABP implant
The vast majority of patients in this study underwent IABP placement to stabilize CS complicating what?
Known systolic heart failure
What is systolic heart failure?
Heart failure with reduced EF.
What is diastolic heart failure?
When the heart can’t properly fill with blood during its resting period, it’s called diastolic heart failure (or heart failure with preserved ejection fraction). This can happen when the heart muscle “bulks up” or thickens from being overworked — as a result of coronary artery disease or hypertension, for instance.Aug 3, 2016
A third of the entire cohort suffered what?
In-hospital adverse event.
This data suggest that _____ & history of _____ together are useful predictors of IABP hemodynamic failure
LVCPI & ICM
Power is equal to the product of ____ & ____
Flow and pressure
Patients on IABP had higher heart rates which may had effected what?
IABP efficiency.
__________ can play a significant role in outcomes in cardiogenic shock.
Inflammation
