Temporal trends of survival and utilization of mechanical circulatory support devices in patients with in-hospital cardiac arrest secondary to ventricular tachycardia/ventricular fibrillation

Nileshkumar J. Patel, Varunsiri Atti, Varun Kumar, Andrew Panakos, Mahesh Anantha Narayanan, Bhaskar Bhardwaj, Shilpkumar Arora, Abhishek J. Deshmukh, Nish Patel, Mir B. Basir, Mauricio G. Cohen, Annapoorna S. Kini, Samin K. Sharma, George Dangas, William W. O'Neill, Carlos E. Alfonso

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Pulseless ventricular tachycardia/ventricular fibrillation (VT/VF) is the initial rhythm in a third of in-hospital cardiac arrest patients. Mechanical circulatory support (MCS) device use remains poorly understood in this population. Methods: We conducted an observational analysis of temporal trends in the utilization of MCS in VT/VF IHCA between January 2008 and December 2014 utilizing the Nationwide Inpatient Sample (NIS) database. Using multivariable analysis, we assessed factors associated with MCS use and survival to discharge. Results: Among 151,628 hospitalizations with VT/VF IHCA, 14,981 (9.9%) received MCS. Intra-aortic balloon pump (IABP) was the most commonly used MCS (9.1%). From 2008 to 2014, there was significant increase in the utilization of MCS (8.7–11%; ptrend < 0.0001). On multivariable analysis, there was 12-fold increase and three-fold increase in the utilization of PVAD and ECMO respectively; however, there was no significant change in the use of IABP. Over the seven-year sample period, there was significant increase in the overall survival to hospital discharge (35.4–43.5%; ptrend < 0.0001). Survival to hospital discharge increased in both MCS and non-MCS groups. Conclusion: There was significant increase in utilization of MCS after VT/VF IHCA during the study period. IABP was the most commonly utilized MCS. The survival to hospital discharge increased in the overall study population including both MCS and non-MCS groups. Future studies are needed to identify patient population most likely to benefit from the use of MCS after VT/VF IHCA.

Original languageEnglish (US)
Pages (from-to)578-587
Number of pages10
JournalCatheterization and Cardiovascular Interventions
Volume94
Issue number4
DOIs
StatePublished - Oct 1 2019
Externally publishedYes

Fingerprint

Ventricular Fibrillation
Ventricular Tachycardia
Heart Arrest
Equipment and Supplies
Survival
Self-Help Groups
Population
Statistical Factor Analysis
Inpatients
Hospitalization
Databases

Keywords

  • extracorporeal membrane oxygenator
  • intra-aortic balloon pump
  • mechanical circulatory support
  • percutaneous ventricular assist device
  • ventricular tachycardia/ventricular fibrillation-in hospital cardiac arrest

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Temporal trends of survival and utilization of mechanical circulatory support devices in patients with in-hospital cardiac arrest secondary to ventricular tachycardia/ventricular fibrillation. / Patel, Nileshkumar J.; Atti, Varunsiri; Kumar, Varun; Panakos, Andrew; Anantha Narayanan, Mahesh; Bhardwaj, Bhaskar; Arora, Shilpkumar; Deshmukh, Abhishek J.; Patel, Nish; Basir, Mir B.; Cohen, Mauricio G.; Kini, Annapoorna S.; Sharma, Samin K.; Dangas, George; O'Neill, William W.; Alfonso, Carlos E.

In: Catheterization and Cardiovascular Interventions, Vol. 94, No. 4, 01.10.2019, p. 578-587.

Research output: Contribution to journalArticle

Patel, NJ, Atti, V, Kumar, V, Panakos, A, Anantha Narayanan, M, Bhardwaj, B, Arora, S, Deshmukh, AJ, Patel, N, Basir, MB, Cohen, MG, Kini, AS, Sharma, SK, Dangas, G, O'Neill, WW & Alfonso, CE 2019, 'Temporal trends of survival and utilization of mechanical circulatory support devices in patients with in-hospital cardiac arrest secondary to ventricular tachycardia/ventricular fibrillation', Catheterization and Cardiovascular Interventions, vol. 94, no. 4, pp. 578-587. https://doi.org/10.1002/ccd.28138
Patel, Nileshkumar J. ; Atti, Varunsiri ; Kumar, Varun ; Panakos, Andrew ; Anantha Narayanan, Mahesh ; Bhardwaj, Bhaskar ; Arora, Shilpkumar ; Deshmukh, Abhishek J. ; Patel, Nish ; Basir, Mir B. ; Cohen, Mauricio G. ; Kini, Annapoorna S. ; Sharma, Samin K. ; Dangas, George ; O'Neill, William W. ; Alfonso, Carlos E. / Temporal trends of survival and utilization of mechanical circulatory support devices in patients with in-hospital cardiac arrest secondary to ventricular tachycardia/ventricular fibrillation. In: Catheterization and Cardiovascular Interventions. 2019 ; Vol. 94, No. 4. pp. 578-587.
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abstract = "Background: Pulseless ventricular tachycardia/ventricular fibrillation (VT/VF) is the initial rhythm in a third of in-hospital cardiac arrest patients. Mechanical circulatory support (MCS) device use remains poorly understood in this population. Methods: We conducted an observational analysis of temporal trends in the utilization of MCS in VT/VF IHCA between January 2008 and December 2014 utilizing the Nationwide Inpatient Sample (NIS) database. Using multivariable analysis, we assessed factors associated with MCS use and survival to discharge. Results: Among 151,628 hospitalizations with VT/VF IHCA, 14,981 (9.9{\%}) received MCS. Intra-aortic balloon pump (IABP) was the most commonly used MCS (9.1{\%}). From 2008 to 2014, there was significant increase in the utilization of MCS (8.7–11{\%}; ptrend < 0.0001). On multivariable analysis, there was 12-fold increase and three-fold increase in the utilization of PVAD and ECMO respectively; however, there was no significant change in the use of IABP. Over the seven-year sample period, there was significant increase in the overall survival to hospital discharge (35.4–43.5{\%}; ptrend < 0.0001). Survival to hospital discharge increased in both MCS and non-MCS groups. Conclusion: There was significant increase in utilization of MCS after VT/VF IHCA during the study period. IABP was the most commonly utilized MCS. The survival to hospital discharge increased in the overall study population including both MCS and non-MCS groups. Future studies are needed to identify patient population most likely to benefit from the use of MCS after VT/VF IHCA.",
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AU - Patel, Nileshkumar J.

AU - Atti, Varunsiri

AU - Kumar, Varun

AU - Panakos, Andrew

AU - Anantha Narayanan, Mahesh

AU - Bhardwaj, Bhaskar

AU - Arora, Shilpkumar

AU - Deshmukh, Abhishek J.

AU - Patel, Nish

AU - Basir, Mir B.

AU - Cohen, Mauricio G.

AU - Kini, Annapoorna S.

AU - Sharma, Samin K.

AU - Dangas, George

AU - O'Neill, William W.

AU - Alfonso, Carlos E.

PY - 2019/10/1

Y1 - 2019/10/1

N2 - Background: Pulseless ventricular tachycardia/ventricular fibrillation (VT/VF) is the initial rhythm in a third of in-hospital cardiac arrest patients. Mechanical circulatory support (MCS) device use remains poorly understood in this population. Methods: We conducted an observational analysis of temporal trends in the utilization of MCS in VT/VF IHCA between January 2008 and December 2014 utilizing the Nationwide Inpatient Sample (NIS) database. Using multivariable analysis, we assessed factors associated with MCS use and survival to discharge. Results: Among 151,628 hospitalizations with VT/VF IHCA, 14,981 (9.9%) received MCS. Intra-aortic balloon pump (IABP) was the most commonly used MCS (9.1%). From 2008 to 2014, there was significant increase in the utilization of MCS (8.7–11%; ptrend < 0.0001). On multivariable analysis, there was 12-fold increase and three-fold increase in the utilization of PVAD and ECMO respectively; however, there was no significant change in the use of IABP. Over the seven-year sample period, there was significant increase in the overall survival to hospital discharge (35.4–43.5%; ptrend < 0.0001). Survival to hospital discharge increased in both MCS and non-MCS groups. Conclusion: There was significant increase in utilization of MCS after VT/VF IHCA during the study period. IABP was the most commonly utilized MCS. The survival to hospital discharge increased in the overall study population including both MCS and non-MCS groups. Future studies are needed to identify patient population most likely to benefit from the use of MCS after VT/VF IHCA.

AB - Background: Pulseless ventricular tachycardia/ventricular fibrillation (VT/VF) is the initial rhythm in a third of in-hospital cardiac arrest patients. Mechanical circulatory support (MCS) device use remains poorly understood in this population. Methods: We conducted an observational analysis of temporal trends in the utilization of MCS in VT/VF IHCA between January 2008 and December 2014 utilizing the Nationwide Inpatient Sample (NIS) database. Using multivariable analysis, we assessed factors associated with MCS use and survival to discharge. Results: Among 151,628 hospitalizations with VT/VF IHCA, 14,981 (9.9%) received MCS. Intra-aortic balloon pump (IABP) was the most commonly used MCS (9.1%). From 2008 to 2014, there was significant increase in the utilization of MCS (8.7–11%; ptrend < 0.0001). On multivariable analysis, there was 12-fold increase and three-fold increase in the utilization of PVAD and ECMO respectively; however, there was no significant change in the use of IABP. Over the seven-year sample period, there was significant increase in the overall survival to hospital discharge (35.4–43.5%; ptrend < 0.0001). Survival to hospital discharge increased in both MCS and non-MCS groups. Conclusion: There was significant increase in utilization of MCS after VT/VF IHCA during the study period. IABP was the most commonly utilized MCS. The survival to hospital discharge increased in the overall study population including both MCS and non-MCS groups. Future studies are needed to identify patient population most likely to benefit from the use of MCS after VT/VF IHCA.

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KW - intra-aortic balloon pump

KW - mechanical circulatory support

KW - percutaneous ventricular assist device

KW - ventricular tachycardia/ventricular fibrillation-in hospital cardiac arrest

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