Predictors of Mortality and Associated Lactate Trends in Cardiogenic Shock Patients Treated with Impella® Placement - A Single Center Experience

Abstract

Background: The Impella® devices have increasingly become a desired treatment option for cardiogenic shock (CS) as demonstrated by studies analyzing real-world use of hemodynamic support devices. However, data regarding outcomes after Impella® device implant and optimal timing of device placement remains scarce. This study investigates prognostic factors including serial lactate levels in CS patients treated with Impella®.Methods: This retrospective study reviewed 76 consecutive patients diagnosed with CS supported with Impella® at a large, tertiary-care university medical center. Clinical variables and outcomes examined include co-morbidities, pre- and post-procedural lactate levels, and mortality.Results: Of the 76 patients requiring an Impella®, 70% of patients survived to hospital discharge. Those who died post-device implant had a higher prevalence of hyperlipidemia (HLD), chronic kidney disease (CKD), and more likely to require multiple (>1) vasopressors. The mean pre-procedural lactate levels were significantly higher (5.86 +/- 5.11 vs 2.16 +/- 1.50, p = 0.01) in the population who died, along with the change in lactate levels (1.90 +/- 2.56 vs -0.40 +/- 1.73, p=0.04). Those who died within 24 hours of implant showed a trend toward higher mean pre-procedural lactate levels (8.46 +/- 6.00 vs 3.86 +/- 3.31, p = 0.12).Conclusions : Higher pre-procedural lactate levels, HLD, CKD, and increased vasopressor requirement were predictive of increased mortality in CS patients post-Impella® placement, especially within 24 hours of implant. Through serial lactate measurements, we demonstrated favorable outcomes in patients with early stabilization or greater lowering of post-procedural lactate levels suggestive of improved end organ perfusion.