Outcomes of a multidisciplinary mechanical circulatory support network in cardiogenic shock in a centre without heart transplant program: A successful interprofessional coordination model

Abstract

Background and objective

Cardiogenic shock (CS) mortality remains very high and mechanical circulatory support (MCS) may provide an effective alternative of treatment in selected patients. The aim of this study is to analyse the results of a multidisciplinary team care program (including anaesthesiologists, cardiologists, cardiothoracic surgeons, and intensivists) in CS patients who required MCS, in a tertiary centre without a heart transplant (HT) program.

Methods

Prospective observational study that sought to analyse the characteristics and survival to discharge predictors in a consecutive CS patients cohort treated with MCS.

Results

A total of 48 patients were included. Mean age was 61 ± 14 years. Before MCS, 45.8% of the patients presented with cardiac arrest. A 54.2% 30-day survival and 45.8% overall survival to discharge, was found. Age and vasoactive-inotropic score were independent predictors of mortality.

Conclusions

A multidisciplinary team-care based MCS program in CS patients is feasible and may achieve favourable results in a centre without HT program.

Resumen

Antecedentes y objetivo

El shock cardiogénico (SC) conlleva una elevada mortalidad, y algunos pacientes pueden beneficiarse del uso de soporte circulatorio mecánico (SCM). El objetivo de este estudio es analizar los resultados de un programa multidisciplinar (constituido por anestesiología y reanimación, cardiología, cirugía cardiaca y medicina intensiva) de atención a pacientes en SC que precisaron SCM en un hospital terciario sin programa de trasplante cardiaco (TC).

Materiales y métodos

Estudio prospectivo observacional que analiza las características y predictores de supervivencia hospitalaria de los pacientes con SC que precisaron SCM.

Resultados

Se incluyeron 48 pacientes. Edad media 61 ± 14 años. El 45,8% presentaron parada cardiaca previa al implante. La supervivencia a 30 días fue del 54,2% y la supervivencia al alta hospitalaria, del 45,8%. La edad y la escala de vasoactivos inotrópicos fueron predictores independientes de mortalidad.

Conclusiones

La instauración de un programa multidisciplinar de SCM en un centro sin programa de TC es factible y aplicable a pacientes con SC, con resultados favorables en cuanto a supervivencia hospitalaria.