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Master Thesis

Score prédictif de survie des candidats à l’Impella chez les patients INTERMACS 1 en vue d’un sevrage d’ECMO-VA

Abstract : Veno-arterial extracorporeal life support (VA-ECLS) followed by early weaning with Impella 5.0 is the treatment of choice in INTERMACS 1 patients with refractory and durable cardiogenic shock. We describe a simple metabolic score identifying good candidates for the bridge from VA-ECMO to Impella 5.0. Forty-one consecutive INTERMACS 1 patients with VA-ECMO, who underwent prospective multiparametric measurements right before Impella 5.0 implantation, were followed-up for 30 days. Impella 5.0 was used for weaning VA-ECMO by unloading the LV 30.2 hours following VA-ECMO implantation. Of these, 25 died 6±6 days after Impella 5.0 implantation. They were older (53±12 vs. 43±12 years old, p=0.01) with acute coronary syndrome as primary etiology (64% vs 13%, p=0.0007) of VA-ECMO implantation. In univariate analysis, patients who died exhibited a lower mean arterial pressure (74±17 vs. 89±9 mm Hg, p=0.01), a higher increase in troponin (24000±38000 vs. 3500±5000 UI, p=0.048), a higher serum lactate (8.3±7.4 vs 4.2± 3.8 mmol/l, p=0.05) and had more frequently a cardiac arrest at admission (80% vs. 25%, p=0.03). By multivariate Cox regression analysis, independent predictors of death events were as follows: an increase in serum lactate concentration >7.9 mmol/l (p=0.008) and an increase in troponin>2700 UI (p=0.028). When patients were grouped as having 0, 1 or 2 high-risk predictors of death, mortality rate was 29%, 75% and 100% in less than 30 days, respectively (Log rank, p=0.0001). Both serum lactate and troponin could be useful to identify a high-risk subset of INTERMACS 1 patients under VA-ECMO, awaiting Impella 5.0 implantation as bridge for weaning.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03546208
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Submitted on : Thursday, January 27, 2022 - 6:28:44 PM
Last modification on : Wednesday, February 23, 2022 - 3:28:25 AM

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Estelle Dovonou. Score prédictif de survie des candidats à l’Impella chez les patients INTERMACS 1 en vue d’un sevrage d’ECMO-VA. Médecine humaine et pathologie. 2021. ⟨dumas-03546208⟩

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