Advertisement
Heart, Lung and Circulation

Outcomes of Cardiac Arrest and Cardiopulmonary Resuscitation in Patients With Left Ventricular Assist Device; an Insight From a National Inpatient Sample

      Background

      Outcomes of patients with implanted left ventricular assist device (LVAD) implantation experiencing a cardiac arrest (CA) are not well reported. We aimed at defining the in-hospital outcomes of patients with implanted LVAD experiencing a CA.

      Methods

      The national inpatient sample (NIS) was queried using ICD9/ICD10 codes for patients older than 18 years with implanted LVAD and CA between 2010–2018. We excluded patients with orthotropic heart transplantation, biventricular assist device (BiVAD) implantation and do not resuscitate (DNR) status.

      Results

      A total of 93,153 hospitalisations between 2010 and 2018 with implanted LVAD were identified. Only 578 of these hospitalisations had experienced CA and of those, 173 (33%) hospitalisations underwent cardiopulmonary resuscitation (CPR). The mean age of hospitalisations that experienced a CA was 60.61±14.85 for non-survivors and 56.23±17.33 for survivors (p=0.14). The in-hospital mortality was 60.8% in hospitalisations with CA and 74.33% in hospitalisations in whom CPR was performed. In an analysis comparing survivors with non-survivors, non-survivors had more diabetes mellitus (DM) (p=0.01), and ischaemic heart disease (IHD) (p=0.04). Age, female sex, peripheral vascular disease and history of coronary artery bypass graft (CABG) were independently associated with increased mortality in our cohort. Also, ventricular tachycardia (VT) and CPR were independently associated with in-hospital mortality. During the study period, there was a significantly decreasing trend in performing CPR in LVAD hospitalisations with CA.

      Conclusion

      In conclusion, age, female sex, peripheral vascular disease, history of CABG, VT and CPR were independently associated with in-hospital mortality in LVAD hospitalisations who experienced CA.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Heart, Lung and Circulation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Gustafsson F.
        • Rogers J.G.
        Left ventricular assist device therapy in advanced heart failure: patient selection and outcomes.
        Eur J Heart Fail. 2017; 19: 595-602
        • Rose E.A.
        • Gelijns A.C.
        • Moskowitz A.J.
        • Heitjan D.F.
        • Stevenson L.W.
        • Dembitsky W.
        • et al.
        Long-term use of a left ventricular assist device for end-stage heart failure.
        N Engl J Med. 2001; 345: 1435-1443
        • Slaughter M.S.
        • Rogers J.G.
        • Milano C.A.
        • Russell S.D.
        • Conte J.V.
        • Feldman D.
        • et al.
        Advanced heart failure treated with continuous-flow left ventricular assist device.
        N Engl J Med. 2009; 361: 2241-2251
        • Kirklin J.K.
        • Naftel D.C.
        • Pagani F.D.
        • Kormos R.L.
        • Stevenson L.W.
        • Blume E.D.
        • et al.
        Sixth INTERMACS annual report: A 10,000-patient database.
        J Heart Lung Transplant. 2014; 33: 555-564
        • Kiamanesh O.
        • Kaan A.
        • Toma M.
        Medical management of left ventricular assist device patients: a practical guide for the nonexpert clinician.
        Can J Cardiol. 2020; 36: 205-215
        • Peberdy M.A.
        • Gluck J.A.
        • Ornato J.P.
        • Bermudez C.A.
        • Griffin R.E.
        • Kasirajan V.
        • et al.
        Cardiopulmonary resuscitation in adults and children with mechanical circulatory support: a scientific statement from the American Heart Association.
        Circulation. 2017; 135: e1115-e1134
        • DeVore A.D.
        • Patel P.A.
        • Patel C.B.
        Medical management of patients with a left ventricular assist device for the non-left ventricular assist device specialist.
        JACC Heart Fail. 2017; 5: 621-631
        • NIS
        Introduction to the HCUP Nationwide Inpatient Sample (NIS).
        2011
        • Shinar Z.
        • Bellezzo J.
        • Stahovich M.
        • Cheskes S.
        • Chillcott S.
        • Dembitsky W.
        Chest compressions may be safe in arresting patients with left ventricular assist devices (LVADs).
        Resuscitation. 2014; 85: 702-704
        • Garg S.
        • Ayers C.R.
        • Fitzsimmons C.
        • Meyer D.
        • Peltz M.
        • Bethea B.
        • et al.
        In-hospital cardiopulmonary arrests in patients with left ventricular assist devices.
        J Card Fail. 2014; 20: 899-904
        • Fugate J.E.
        • Brinjikji W.
        • Mandrekar J.N.
        • Cloft H.J.
        • White R.D.
        • Wijdicks E.F.
        • et al.
        Post-cardiac arrest mortality is declining: A study of the US national inpatient sample 2001 to 2009.
        Circulation. 2012; 126: 546-550
        • Kolte D.
        • Khera S.
        • Aronow W.S.
        • Palaniswamy C.
        • Mujib M.
        • Ahn C.
        • et al.
        Regional variation in the incidence and outcomes of in-hospital cardiac arrest in the United States.
        Circulation. 2015; 131: 1415-1425
        • Wallmuller C.
        • Meron G.
        • Kurkciyan I.
        • Schober A.
        • Stratil P.
        • Sterz F.
        Causes of in-hospital cardiac arrest and influence on outcome.
        Resuscitation. 2012; 83: 1206-1211
        • Galand V.
        • Flécher E.
        • Auffret V.
        • Boulé S.
        • Vincentelli A.
        • Dambrin C.
        • et al.
        Predictors and clinical impact of late ventricular arrhythmias in patients with continuous-flow left ventricular assist devices.
        JACC Clin Electrophysiol. 2018; 4: 1166-1175
        • Martins R.P.
        • Leclercq C.
        • Bourenane H.
        • Auffret V.
        • Boulé S.
        • Loobuyck V.
        • et al.
        Incidence, predictors, and clinical impact of electrical storm in patients with left ventricular assist devices: New insights from the ASSIST-ICD study.
        Heart Rhythm. 2019; 16: 1506-1512
        • Maradey J.A.
        • Singleton M.J.
        • O’Neill T.J.
        • Bhave P.D.
        Management of ventricular arrhythmias in patients with LVAD.
        Curr Opin Cardiol. 2020; 35: 289-294
        • Ehlenbach W.J.
        • Barnato A.E.
        • Curtis J.R.
        • Kreuter W.
        • Koepsell T.D.
        • Deyo R.A.
        • et al.
        Epidemiologic study of in-hospital cardiopulmonary resuscitation in the elderly.
        N Engl J Med. 2009; 361: 22-31
        • Kazaure H.S.
        • Roman S.A.
        • Sosa J.A.
        Epidemiology and outcomes of in-hospital cardiopulmonary resuscitation in the United States, 2000-2009.
        Resuscitation. 2013; 84: 1255-1260
        • Iwashita Y.
        • Ito A.
        • Sasaki K.
        • Suzuki K.
        • Fujioka M.
        • Maruyama K.
        • et al.
        Cardiopulmonary resuscitation of a cardiac arrest patient with left ventricular assist device in an out-of-hospital setting: A case report.
        Medicine (United States). 2020; 99: e18658
        • Pratt A.K.
        • Shah N.S.
        • Boyce S.W.
        Left ventricular assist device management in the ICU.
        Crit Care Med. 2014; 42: 158-168
        • Perman S.M.
        • Beaty B.L.
        • Daugherty S.L.
        • Havranek E.P.
        • Haukoos J.S.
        • Juarez-Colunga E.
        • et al.
        Do sex differences exist in the establishment of “do not attempt resuscitation” orders and survival in patients successfully resuscitated from in-hospital cardiac arrest?.
        J Am Heart Assoc. 2020; 9: e014200
        • Morrison L.J.
        • Schmicker R.H.
        • Weisfeldt M.L.
        • Bigham B.L.
        • Berg R.A.
        • Topjian A.A.
        • et al.
        Effect of gender on outcome of out of hospital cardiac arrest in the Resuscitation Outcomes Consortium.
        Resuscitation. 2016; 100: 76-81