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Multicenter Study
. 2020 Jun 1;5(6):703-708.
doi: 10.1001/jamacardio.2020.0692.

Use of Temporary Mechanical Circulatory Support for Management of Cardiogenic Shock Before and After the United Network for Organ Sharing Donor Heart Allocation System Changes

Anubodh S Varshney  1 , David D Berg  1 , Jason N Katz  2   3   4 , Vivian M Baird-Zars  1 , Erin A Bohula  1 , Anthony P Carnicelli  4 , Sunit-Preet Chaudhry  5 , Jianping Guo  1 , Patrick R Lawler  6   7 , Jose Nativi-Nicolau  8 , Shashank S Sinha  9 , Jeffrey J Teuteberg  10 , Sean van Diepen  11   12 , David A Morrow  1 ; Critical Care Cardiology Trials Network Investigators
Affiliations
Multicenter Study

Use of Temporary Mechanical Circulatory Support for Management of Cardiogenic Shock Before and After the United Network for Organ Sharing Donor Heart Allocation System Changes

Anubodh S Varshney et al. JAMA Cardiol. .

Abstract

Importance: The new United Network for Organ Sharing (UNOS) donor heart allocation system gives priority to patients supported with nondischargeable mechanical circulatory support (MCS) devices while awaiting heart transplant. Whether there has been a change in temporary MCS use in cardiac intensive care units (CICUs) since the implementation of this policy is unknown.

Objectives: To examine whether the UNOS donor heart allocation system revision in October 2018 was associated with changes in temporary MCS use in CICUs and whether temporary MCS use differed between US transplant centers and US nontransplant centers and Canadian centers.

Design, setting, and participants: In this cohort study, 14 centers from the Critical Care Cardiology Trials Network (CCCTN), a multicenter network of tertiary CICUs in North America, contributed 2-month snapshots of consecutive medical CICU admissions between September 1, 2017, and September 1, 2018 (prerevision period), and October 1, 2018, and September 1, 2019 (postrevision period). CICUs were classified as US transplant centers (n = 7) or other CICUs (US nontransplant centers or Canadian centers; n = 7).

Exposure: Revision to the UNOS donor heart allocation system.

Main outcomes and measures: Treatment with temporary MCS (intra-aortic balloon pump, microaxial intracardiac ventricular assist device, percutaneous centrifugal ventricular assist device, venoarterial extracorporeal membrane oxygenation, or surgically implanted, nondischargeable MCS device) during hospital admission.

Results: A total of 384 admissions for acute, decompensated, heart failure-related cardiogenic shock (ADHF-CS) were included, among which 248 (64.6%) were to US transplant centers; 126 admissions (51%) were in the prerevision period and 122 (49%) were in the postrevision period. The mean (SD) patient age was 61.2 (14.6) years; 246 patients (64.1%) were male. The proportion of admissions with ADHF-CS managed with temporary MCS at US transplant centers significantly increased from 25.4% (32 of 126 admissions) before to 42.6% (52 of 122 admissions) after the UNOS allocation system changes (P = .004). In other CICUs, the proportion did not significantly change (24.5% [13 of 53 admissions] to 24.1% [20 of 83 admissions]; P = .95). After multivariable adjustment, patients admitted to US transplant centers in the postrevision period were more likely to receive temporary MCS compared with those admitted in the prerevision period (adjusted odds ratio, 2.19; 95% CI, 1.13-4.24; P = .02).

Conclusions and relevance: In the year after implementation of the new UNOS donor heart allocation system, temporary MCS use in patients admitted with ADHF-CS increased in US transplant centers but not in other CICUs. Whether this shift in practice will affect outcomes of patients with ADHF-CS or organ distribution should be evaluated.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Katz reported receiving research support from Abbott Corporation outside the submitted work. Dr Carnicelli reported receiving grants from the National Institutes of Health during the conduct of the study. Dr Berg, Dr Bohula, Ms Baird-Zars, Dr Guo, and Dr Morrow reported serving as a member of the TIMI Study Group, which has received institutional research grant support through Brigham and Women's from Abbott Laboratories, Amgen, AstraZeneca, Critical Diagnostics, Daiichi-Sankyo, Eisai, Genzyme, Gilead, GlaxoSmithKline, Intarcia, Janssen Research and Development, Medicines Company, MedImmune, Merck, Novartis, Pfizer, Poxel, Roche Diagnostics, and Takeda. Dr Nativi-Nicolau’s institution received funding for clinical trials for Pfizer, Akcea, and Eidos and educational grants from Pfizer. Dr Nativi-Nicolau has been a consultant for Pfizer, Eidos, Akcea, and Alnylam. Dr Sinha reported receiving personal fees from Abiomed outside the submitted work. Dr Teuteberg reported receiving personal fees from Abiomed, Medtronic, Abbott, CareDx, and EcoR1 outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Temporary Mechanical Circulatory Support (MCS) Use in US Transplant Centers and Other Cardiac Intensive Care Units (CICUs)
A, Temporary MCS use before and after United Network for Organ Sharing (UNOS) donor heart allocation system changes. B, Device use by type at US transplant centers before and after UNOS donor heart allocation system changes. IABP indicates intra-aortic balloon pump; PVAD, percutaneous centrifugal ventricular assist device; and VA-ECMO, venoarterial extracorporeal membrane oxygenation.
See this image and copyright information in PMC

References

    1. US Department of Health and Human Services, Organ Procurement and Transplantation Network Adult heart allocation. June 15, 2019. Accessed December 1, 2019. https://optn.transplant.hrsa.gov/learn/professional-education/adult-hear...
    1. Cogswell R, John R, Estep JD, et al. . An early investigation of outcomes with the new 2018 donor heart allocation system in the United States. J Heart Lung Transplant. 2020;39(1):1-4. doi:10.1016/j.healun.2019.11.002 - DOI - PubMed
    1. Morrow DA, Fang JC, Fintel DJ, et al. ; American Heart Association Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation, Council on Clinical Cardiology, Council on Cardiovascular Nursing, and Council on Quality of Care and Outcomes Research . Evolution of critical care cardiology: transformation of the cardiovascular intensive care unit and the emerging need for new medical staffing and training models: a scientific statement from the American Heart Association. Circulation. 2012;126(11):1408-1428. doi:10.1161/CIR.0b013e31826890b0 - DOI - PubMed
    1. Bohula EA, Katz JN, van Diepen S, et al. ; Critical Care Cardiology Trials Network . Demographics, care patterns, and outcomes of patients admitted to cardiac intensive care units: the Critical Care Cardiology Trials Network prospective North American multicenter registry of cardiac critical illness. JAMA Cardiol. 2019;4(9):928-935. doi:10.1001/jamacardio.2019.2467 - DOI - PMC - PubMed
    1. Berg DD, Bohula EA, van Diepen S, et al. . Epidemiology of shock in contemporary cardiac intensive care units. Circ Cardiovasc Qual Outcomes. 2019;12(3):e005618. doi:10.1161/CIRCOUTCOMES.119.005618 - DOI - PMC - PubMed

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