• Andrew M Goldsweig, Hyo Jung Tak, M Chadi Alraies, James Park, Craig Smith, John Baker, Lang Lin, Nainesh Patel, William W O'Neill, Mir B Basir, and National Cardiogenic Shock Initiative Investigators.
• University of Nebraska Medical Center, Omaha, NE, United States of America. Electronic address: andrew.goldsweig@unmc.edu.
• Cardiovasc Revasc Med. 2020 Dec 22.

BackgroundEvidence is limited regarding the role of mechanical circulatory support (MCS) in patients with acute coronary syndromes (ACS) complicated by cardiogenic shock (CGS). In particular, the role of MCS in patients with out-of-hospital cardiac arrest (OHCA) is unknown.MethodsThe National Cardiogenic Shock Initiative (NCSI) is a multicenter United States registry of patients with ACS complicated by CGS treated with MCS. We compared the rate of survival to hospital discharge among patients with OHCA, in-hospital cardiac arrest (IHCA), or no cardiac arrest. We subsequently used multivariable analyses to determine independent predictors of OHCA survival.ResultsSurvival to hospital discharge occurred in 85.7% (42/49) of OHCA, 72.4% (50/69) of IHCA, and 74.5% (111/149) of non-cardiac arrest patients. By multivariable analysis, pre-procedural predictors of survival included younger age, female sex, fewer diseased vessels, left anterior descending coronary artery culprit, lower troponin, higher lactate, and delayed initiation of MCS. Procedural and post-procedural predictors of survival included fewer vessels treated, complete revascularization, higher post-MCS cardiac power output, and fewer inotropic medications required.ConclusionsThis study demonstrates that excellent outcomes may be achieved following OHCA when MCS is employed for patients appropriately selected by prognostic demographic, anatomic, and health status characteristics. A larger study population, currently being enrolled, is needed to validate the observation further.Copyright © 2020 Elsevier Inc. All rights reserved.

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