A21 - Impact of Concomitant Vasoactive Treatment in Active Left Ventricular Unloading in Cardiogenic Shock

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Support:The development of this supplement was funded by Abiomed.

Correspondence Details:Nanna Udensen,

Open Access:

The copyright in this work belongs to Radcliffe Medical Media. Only articles clearly marked with the CC BY-NC logo are published with the Creative Commons by Attribution Licence. The CC BY-NC option was not available for Radcliffe journals before 1 January 2019. Articles marked ‘Open Access’ but not marked ‘CC BY-NC’ are made freely accessible at the time of publication but are subject to standard copyright law regarding reproduction and distribution. Permission is required for reuse of this content.

Background: In patients with acute MI and cardiogenic shock (CS) treated with Impella CP, concomitant vasoactive drugs are often required. Studies investigating vasoactive drugs in combination with Impella CP and their impact on end-organ perfusion and left ventricular (LV) workload are lacking.

Hypothesis: The aim of this study was to investigate and compare the effect of adrenaline (AD), dopamine (DA), noradrenalin (NA) or phenylephrine (PE) in combination with Impella CP on end-organ perfusion and LV workload in a porcine model of CS.

Methods: CS was induced in nine pigs by stepwise injection of microspheres into the left main coronary artery. After 30 minutes with Impella CP support, pigs were randomised in a blinded crossover design to an infusion with either NA (0.10 µg/kg/min), AD (0.10 µg/kg/min) or DA (10 µg/kg/min) for 30 minutes each. PE (10 µg/kg/min) was given last for 20 minutes.

Additional NA infusion was allowed to maintain mean arterial pressure >50 mmHg. LV workload was evaluated by pressure–volume area (PVA) × HR measured by conductance catheter technique. End-organ perfusion was evaluated by venous oxygen saturations, from jugular bulb and renal vein catheters. Lactate level was measured in arterial blood at the end of each stage. Multilevel mixed-effects linear regression was used to assess differences from the Impella support only.

Results: All drugs, except NA, increased PVA × HR significantly. Arterial lactate increased during PE by 2.48 mmol/l (95% CI [0.87–4.08]), while no significant change was observed during DA, NA and AD. Renal oxygen saturation declined during PE infusion by −13 percentage points (95% CI [−24, −2]), while other drugs caused a non-significant increase. A similar trend was seen in cerebral oxygen saturation.

Conclusion: In a porcine model with profound CS treated with the Impella CP, vasoactive treatments, with the exception of NA, significantly increased LV workload. Venous saturations increased, although non-significantly, with all infusions, except PE, causing a reduction in venous saturations and increased arterial lactate level, indicating reduced organ perfusion.