Cardiogenic shock treated with temporary mechanical circulatory support in Brazil: The effect of learning curve
Aims: Treatment with mechanical circulatory support (MCS) has been proposed to mitigate mortality in cardiogenic shock (CS). However, there is a lack of data on MCS programs implementation and the effect of the learning curve on its outcomes in limited resources countries such as Brazil. Methods: Pr...
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| Veröffentlicht in: | International journal of artificial organs 2022-03, Vol.45 (3), p.292-300 |
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| creator | Scolari, Fernando Luís Trott, Geraldine Schneider, Daniel Goldraich, Livia Adams Frederico Tonietto, Tulio Moura, Lídia Zytynski Bertoldi, Eduardo Gehling Rover, Marciane Maria Wolf, Jonas Michel Souza, Denise de Clausell, Nadine Polanczyk, Carisi Anne Rohde, Luis Eduardo Rosa, Regis Goulart Wainstein, Rodrigo Vugman |
| description | Aims:
Treatment with mechanical circulatory support (MCS) has been proposed to mitigate mortality in cardiogenic shock (CS). However, there is a lack of data on MCS programs implementation and the effect of the learning curve on its outcomes in limited resources countries such as Brazil.
Methods:
Prospective cohort of patients with CS admitted in four tertiary-care centers treated with Impella CP or veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Clinical outcomes were peri-procedural complications, short-term mortality rate, and the centers’ learning curve. The cohort was divided into two periods: from April 2017 to July 2018 (n = 24), and from August 2018 to December 2020 (n = 25).
Results:
The study enrolled 49 patients [age 59 (43–63) years; 34 (70%) males]. The most common causes for CS were acute myocardial infarction in 22 (45%) and acute decompensation of chronic heart failure in 10 (20%). VA-ECMO was employed in 35 (71%) and Impella CP in 14 (29%) of patients. Overall complications occurred in 37 (76%) of patients, where major bleeding in 19 (38%) was the most common. The overall mortality rate was 61%, but it was lower in the second period (40%) in comparison to the first period (83%), p = 0.002. The learning curve analysis showed a decrease in the mortality rate after 40 consecutive cases.
Conclusions:
Implementation of a temporary MCS program for refractory CS in a limited resource country is feasible. The learning curve effect might have played a role on survival rate since high morbimortality has decreased within time reaching optimal results by the end of the study. |
| doi_str_mv | 10.1177/03913988211070841 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2622656534</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_03913988211070841</sage_id><sourcerecordid>2622656534</sourcerecordid><originalsourceid>FETCH-LOGICAL-c368t-e8ff8081c90b798874e1a6b5a8d8d2ec9b3097cded2a27a49b045fc10bd00bda3</originalsourceid><addsrcrecordid>eNp10UtPxCAQAGBiNLo-foAXQ-LFSxUKLdSbbnwlJl7Wc0PpdBdtywpUo79eml010XggJPDNDMwgdEjJKaVCnBFWUFZImVJKBJGcbqAJFSlPcsLJJpqM98kIdtCu90-E0JzzbBvtsIyIrGBiguxUudrYOfRGY7-w-hkHBypAjd9MWOAA3dI65d5xB3qholIt1sbpoVXBxmM_LCMI2PT40qkP057j2QIwNA3ogG2DW1CuN_0c68G9wj7aalTr4WC976HH66vZ9Da5f7i5m17cJ5rlMiQgm0YSSXVBKhE_IDhQlVeZkrWsU9BFxUghdA11qlKheFERnjWakqomcSm2h05WeZfOvgzgQ9kZr6FtVQ928GWap2me5RnjkR7_ok92cH18XVSMZ1JSOSq6UtpZ7x005dKZLjampKQcp1H-mUaMOVpnHqoO6u-Ir_ZHcLoCXs3hp-z_GT8BxvqTFg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2634588184</pqid></control><display><type>article</type><title>Cardiogenic shock treated with temporary mechanical circulatory support in Brazil: The effect of learning curve</title><source>MEDLINE</source><source>SAGE Journals</source><creator>Scolari, Fernando Luís ; Trott, Geraldine ; Schneider, Daniel ; Goldraich, Livia Adams ; Frederico Tonietto, Tulio ; Moura, Lídia Zytynski ; Bertoldi, Eduardo Gehling ; Rover, Marciane Maria ; Wolf, Jonas Michel ; Souza, Denise de ; Clausell, Nadine ; Polanczyk, Carisi Anne ; Rohde, Luis Eduardo ; Rosa, Regis Goulart ; Wainstein, Rodrigo Vugman</creator><creatorcontrib>Scolari, Fernando Luís ; Trott, Geraldine ; Schneider, Daniel ; Goldraich, Livia Adams ; Frederico Tonietto, Tulio ; Moura, Lídia Zytynski ; Bertoldi, Eduardo Gehling ; Rover, Marciane Maria ; Wolf, Jonas Michel ; Souza, Denise de ; Clausell, Nadine ; Polanczyk, Carisi Anne ; Rohde, Luis Eduardo ; Rosa, Regis Goulart ; Wainstein, Rodrigo Vugman</creatorcontrib><description>Aims:
Treatment with mechanical circulatory support (MCS) has been proposed to mitigate mortality in cardiogenic shock (CS). However, there is a lack of data on MCS programs implementation and the effect of the learning curve on its outcomes in limited resources countries such as Brazil.
Methods:
Prospective cohort of patients with CS admitted in four tertiary-care centers treated with Impella CP or veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Clinical outcomes were peri-procedural complications, short-term mortality rate, and the centers’ learning curve. The cohort was divided into two periods: from April 2017 to July 2018 (n = 24), and from August 2018 to December 2020 (n = 25).
Results:
The study enrolled 49 patients [age 59 (43–63) years; 34 (70%) males]. The most common causes for CS were acute myocardial infarction in 22 (45%) and acute decompensation of chronic heart failure in 10 (20%). VA-ECMO was employed in 35 (71%) and Impella CP in 14 (29%) of patients. Overall complications occurred in 37 (76%) of patients, where major bleeding in 19 (38%) was the most common. The overall mortality rate was 61%, but it was lower in the second period (40%) in comparison to the first period (83%), p = 0.002. The learning curve analysis showed a decrease in the mortality rate after 40 consecutive cases.
Conclusions:
Implementation of a temporary MCS program for refractory CS in a limited resource country is feasible. The learning curve effect might have played a role on survival rate since high morbimortality has decreased within time reaching optimal results by the end of the study.</description><identifier>ISSN: 0391-3988</identifier><identifier>EISSN: 1724-6040</identifier><identifier>DOI: 10.1177/03913988211070841</identifier><identifier>PMID: 35075937</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Brazil ; Complications ; Congestive heart failure ; Extracorporeal membrane oxygenation ; Heart-Assist Devices - adverse effects ; Humans ; Learning ; Learning Curve ; Learning curves ; Male ; Middle Aged ; Mortality ; Myocardial infarction ; Oxygenation ; Patients ; Prospective Studies ; Shock, Cardiogenic - etiology ; Survival ; Treatment Outcome</subject><ispartof>International journal of artificial organs, 2022-03, Vol.45 (3), p.292-300</ispartof><rights>The Author(s) 2022</rights><rights>Copyright Wichtig Editore s.r.l. Mar 2022</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c368t-e8ff8081c90b798874e1a6b5a8d8d2ec9b3097cded2a27a49b045fc10bd00bda3</citedby><cites>FETCH-LOGICAL-c368t-e8ff8081c90b798874e1a6b5a8d8d2ec9b3097cded2a27a49b045fc10bd00bda3</cites><orcidid>0000-0003-2150-6337 ; 0000-0001-7577-464X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/03913988211070841$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/03913988211070841$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21798,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35075937$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Scolari, Fernando Luís</creatorcontrib><creatorcontrib>Trott, Geraldine</creatorcontrib><creatorcontrib>Schneider, Daniel</creatorcontrib><creatorcontrib>Goldraich, Livia Adams</creatorcontrib><creatorcontrib>Frederico Tonietto, Tulio</creatorcontrib><creatorcontrib>Moura, Lídia Zytynski</creatorcontrib><creatorcontrib>Bertoldi, Eduardo Gehling</creatorcontrib><creatorcontrib>Rover, Marciane Maria</creatorcontrib><creatorcontrib>Wolf, Jonas Michel</creatorcontrib><creatorcontrib>Souza, Denise de</creatorcontrib><creatorcontrib>Clausell, Nadine</creatorcontrib><creatorcontrib>Polanczyk, Carisi Anne</creatorcontrib><creatorcontrib>Rohde, Luis Eduardo</creatorcontrib><creatorcontrib>Rosa, Regis Goulart</creatorcontrib><creatorcontrib>Wainstein, Rodrigo Vugman</creatorcontrib><title>Cardiogenic shock treated with temporary mechanical circulatory support in Brazil: The effect of learning curve</title><title>International journal of artificial organs</title><addtitle>Int J Artif Organs</addtitle><description>Aims:
Treatment with mechanical circulatory support (MCS) has been proposed to mitigate mortality in cardiogenic shock (CS). However, there is a lack of data on MCS programs implementation and the effect of the learning curve on its outcomes in limited resources countries such as Brazil.
Methods:
Prospective cohort of patients with CS admitted in four tertiary-care centers treated with Impella CP or veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Clinical outcomes were peri-procedural complications, short-term mortality rate, and the centers’ learning curve. The cohort was divided into two periods: from April 2017 to July 2018 (n = 24), and from August 2018 to December 2020 (n = 25).
Results:
The study enrolled 49 patients [age 59 (43–63) years; 34 (70%) males]. The most common causes for CS were acute myocardial infarction in 22 (45%) and acute decompensation of chronic heart failure in 10 (20%). VA-ECMO was employed in 35 (71%) and Impella CP in 14 (29%) of patients. Overall complications occurred in 37 (76%) of patients, where major bleeding in 19 (38%) was the most common. The overall mortality rate was 61%, but it was lower in the second period (40%) in comparison to the first period (83%), p = 0.002. The learning curve analysis showed a decrease in the mortality rate after 40 consecutive cases.
Conclusions:
Implementation of a temporary MCS program for refractory CS in a limited resource country is feasible. The learning curve effect might have played a role on survival rate since high morbimortality has decreased within time reaching optimal results by the end of the study.</description><subject>Brazil</subject><subject>Complications</subject><subject>Congestive heart failure</subject><subject>Extracorporeal membrane oxygenation</subject><subject>Heart-Assist Devices - adverse effects</subject><subject>Humans</subject><subject>Learning</subject><subject>Learning Curve</subject><subject>Learning curves</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Myocardial infarction</subject><subject>Oxygenation</subject><subject>Patients</subject><subject>Prospective Studies</subject><subject>Shock, Cardiogenic - etiology</subject><subject>Survival</subject><subject>Treatment Outcome</subject><issn>0391-3988</issn><issn>1724-6040</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10UtPxCAQAGBiNLo-foAXQ-LFSxUKLdSbbnwlJl7Wc0PpdBdtywpUo79eml010XggJPDNDMwgdEjJKaVCnBFWUFZImVJKBJGcbqAJFSlPcsLJJpqM98kIdtCu90-E0JzzbBvtsIyIrGBiguxUudrYOfRGY7-w-hkHBypAjd9MWOAA3dI65d5xB3qholIt1sbpoVXBxmM_LCMI2PT40qkP057j2QIwNA3ogG2DW1CuN_0c68G9wj7aalTr4WC976HH66vZ9Da5f7i5m17cJ5rlMiQgm0YSSXVBKhE_IDhQlVeZkrWsU9BFxUghdA11qlKheFERnjWakqomcSm2h05WeZfOvgzgQ9kZr6FtVQ928GWap2me5RnjkR7_ok92cH18XVSMZ1JSOSq6UtpZ7x005dKZLjampKQcp1H-mUaMOVpnHqoO6u-Ir_ZHcLoCXs3hp-z_GT8BxvqTFg</recordid><startdate>202203</startdate><enddate>202203</enddate><creator>Scolari, Fernando Luís</creator><creator>Trott, Geraldine</creator><creator>Schneider, Daniel</creator><creator>Goldraich, Livia Adams</creator><creator>Frederico Tonietto, Tulio</creator><creator>Moura, Lídia Zytynski</creator><creator>Bertoldi, Eduardo Gehling</creator><creator>Rover, Marciane Maria</creator><creator>Wolf, Jonas Michel</creator><creator>Souza, Denise de</creator><creator>Clausell, Nadine</creator><creator>Polanczyk, Carisi Anne</creator><creator>Rohde, Luis Eduardo</creator><creator>Rosa, Regis Goulart</creator><creator>Wainstein, Rodrigo Vugman</creator><general>SAGE Publications</general><general>Wichtig Editore s.r.l</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QF</scope><scope>7QO</scope><scope>7QQ</scope><scope>7SC</scope><scope>7SE</scope><scope>7SP</scope><scope>7SR</scope><scope>7TA</scope><scope>7TB</scope><scope>7U5</scope><scope>8BQ</scope><scope>8FD</scope><scope>F28</scope><scope>FR3</scope><scope>H8D</scope><scope>H8G</scope><scope>JG9</scope><scope>JQ2</scope><scope>KR7</scope><scope>L7M</scope><scope>L~C</scope><scope>L~D</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2150-6337</orcidid><orcidid>https://orcid.org/0000-0001-7577-464X</orcidid></search><sort><creationdate>202203</creationdate><title>Cardiogenic shock treated with temporary mechanical circulatory support in Brazil: The effect of learning curve</title><author>Scolari, Fernando Luís ; Trott, Geraldine ; Schneider, Daniel ; Goldraich, Livia Adams ; Frederico Tonietto, Tulio ; Moura, Lídia Zytynski ; Bertoldi, Eduardo Gehling ; Rover, Marciane Maria ; Wolf, Jonas Michel ; Souza, Denise de ; Clausell, Nadine ; Polanczyk, Carisi Anne ; Rohde, Luis Eduardo ; Rosa, Regis Goulart ; Wainstein, Rodrigo Vugman</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c368t-e8ff8081c90b798874e1a6b5a8d8d2ec9b3097cded2a27a49b045fc10bd00bda3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Brazil</topic><topic>Complications</topic><topic>Congestive heart failure</topic><topic>Extracorporeal membrane oxygenation</topic><topic>Heart-Assist Devices - adverse effects</topic><topic>Humans</topic><topic>Learning</topic><topic>Learning Curve</topic><topic>Learning curves</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Myocardial infarction</topic><topic>Oxygenation</topic><topic>Patients</topic><topic>Prospective Studies</topic><topic>Shock, Cardiogenic - etiology</topic><topic>Survival</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Scolari, Fernando Luís</creatorcontrib><creatorcontrib>Trott, Geraldine</creatorcontrib><creatorcontrib>Schneider, Daniel</creatorcontrib><creatorcontrib>Goldraich, Livia Adams</creatorcontrib><creatorcontrib>Frederico Tonietto, Tulio</creatorcontrib><creatorcontrib>Moura, Lídia Zytynski</creatorcontrib><creatorcontrib>Bertoldi, Eduardo Gehling</creatorcontrib><creatorcontrib>Rover, Marciane Maria</creatorcontrib><creatorcontrib>Wolf, Jonas Michel</creatorcontrib><creatorcontrib>Souza, Denise de</creatorcontrib><creatorcontrib>Clausell, Nadine</creatorcontrib><creatorcontrib>Polanczyk, Carisi Anne</creatorcontrib><creatorcontrib>Rohde, Luis Eduardo</creatorcontrib><creatorcontrib>Rosa, Regis Goulart</creatorcontrib><creatorcontrib>Wainstein, Rodrigo Vugman</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Aluminium Industry Abstracts</collection><collection>Biotechnology Research Abstracts</collection><collection>Ceramic Abstracts</collection><collection>Computer and Information Systems Abstracts</collection><collection>Corrosion Abstracts</collection><collection>Electronics & Communications Abstracts</collection><collection>Engineered Materials Abstracts</collection><collection>Materials Business File</collection><collection>Mechanical & Transportation Engineering Abstracts</collection><collection>Solid State and Superconductivity Abstracts</collection><collection>METADEX</collection><collection>Technology Research Database</collection><collection>ANTE: Abstracts in New Technology & Engineering</collection><collection>Engineering Research Database</collection><collection>Aerospace Database</collection><collection>Copper Technical Reference Library</collection><collection>Materials Research Database</collection><collection>ProQuest Computer Science Collection</collection><collection>Civil Engineering Abstracts</collection><collection>Advanced Technologies Database with Aerospace</collection><collection>Computer and Information Systems Abstracts Academic</collection><collection>Computer and Information Systems Abstracts Professional</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of artificial organs</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Scolari, Fernando Luís</au><au>Trott, Geraldine</au><au>Schneider, Daniel</au><au>Goldraich, Livia Adams</au><au>Frederico Tonietto, Tulio</au><au>Moura, Lídia Zytynski</au><au>Bertoldi, Eduardo Gehling</au><au>Rover, Marciane Maria</au><au>Wolf, Jonas Michel</au><au>Souza, Denise de</au><au>Clausell, Nadine</au><au>Polanczyk, Carisi Anne</au><au>Rohde, Luis Eduardo</au><au>Rosa, Regis Goulart</au><au>Wainstein, Rodrigo Vugman</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cardiogenic shock treated with temporary mechanical circulatory support in Brazil: The effect of learning curve</atitle><jtitle>International journal of artificial organs</jtitle><addtitle>Int J Artif Organs</addtitle><date>2022-03</date><risdate>2022</risdate><volume>45</volume><issue>3</issue><spage>292</spage><epage>300</epage><pages>292-300</pages><issn>0391-3988</issn><eissn>1724-6040</eissn><abstract>Aims:
Treatment with mechanical circulatory support (MCS) has been proposed to mitigate mortality in cardiogenic shock (CS). However, there is a lack of data on MCS programs implementation and the effect of the learning curve on its outcomes in limited resources countries such as Brazil.
Methods:
Prospective cohort of patients with CS admitted in four tertiary-care centers treated with Impella CP or veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Clinical outcomes were peri-procedural complications, short-term mortality rate, and the centers’ learning curve. The cohort was divided into two periods: from April 2017 to July 2018 (n = 24), and from August 2018 to December 2020 (n = 25).
Results:
The study enrolled 49 patients [age 59 (43–63) years; 34 (70%) males]. The most common causes for CS were acute myocardial infarction in 22 (45%) and acute decompensation of chronic heart failure in 10 (20%). VA-ECMO was employed in 35 (71%) and Impella CP in 14 (29%) of patients. Overall complications occurred in 37 (76%) of patients, where major bleeding in 19 (38%) was the most common. The overall mortality rate was 61%, but it was lower in the second period (40%) in comparison to the first period (83%), p = 0.002. The learning curve analysis showed a decrease in the mortality rate after 40 consecutive cases.
Conclusions:
Implementation of a temporary MCS program for refractory CS in a limited resource country is feasible. The learning curve effect might have played a role on survival rate since high morbimortality has decreased within time reaching optimal results by the end of the study.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>35075937</pmid><doi>10.1177/03913988211070841</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-2150-6337</orcidid><orcidid>https://orcid.org/0000-0001-7577-464X</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0391-3988 |
| ispartof | International journal of artificial organs, 2022-03, Vol.45 (3), p.292-300 |
| issn | 0391-3988 1724-6040 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2622656534 |
| source | MEDLINE; SAGE Journals |
| subjects | Brazil Complications Congestive heart failure Extracorporeal membrane oxygenation Heart-Assist Devices - adverse effects Humans Learning Learning Curve Learning curves Male Middle Aged Mortality Myocardial infarction Oxygenation Patients Prospective Studies Shock, Cardiogenic - etiology Survival Treatment Outcome |
| title | Cardiogenic shock treated with temporary mechanical circulatory support in Brazil: The effect of learning curve |
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