Cardiogenic shock: incidence, survival and mechanical circulatory support usage 2007-2017-insights from a national registry

Abstract

Background: A central element in the management of cardiogenic shock (CS) comprises mechanical circulatory support (MCS) systems to maintain cardiac output (CO). This study aims to quantify incidence, outcome and influence of MCS in CS over the last decade.

Methods: All patients hospitalized with CS in a tertiary university hospital in Germany between 2007 and 2017 were identified utilizing the international coding system ICD-10 with code R57.0. Application of MCS was identified via German procedure classification codes (OPS).

Results: 383,983 cases of cardiogenic shock were reported from 2007 to 2017. Patients had a mean age of 71 years and 38.5% were female. The incidence of CS rose by 65.6% from 26,828 cases in 2007 (33.1 per 100,000 person-years, hospital survival 39.2%) to 44,425 cases in 2017 (53.7 per 100,000 person-years, survival 41.2%). In 2007, 16.0% of patients with CS received MCS (4.6 per 100,000 person-years, survival 46.6%), dropping to 13.9% in 2017 (6.6 per 100,000 person-years, survival 38.6%). Type of MCS changed over the years, with decreasing use of the intra-aortic balloon pump (IABP), an increase in extracorporeal membrane oxygenation (VA-ECMO) and percutaneous ventricular assist device (pVAD) usage. Significant differences regarding in-hospital survival were observed between the devices (survival: overall: 40.2%; medical treatment = 39.5%; IABP = 49.5%; pVAD = 36.2%; VA-ECMO = 30.5%; p < 0.001).

Conclusions: The incidence of CS is increasing, but hospital survival remains low. MCS was used in a minority of patients, and the percentage of MCS usage in CS has decreased. The use rates of the competing devices change over time.

Keywords: Cardiogenic shock; ECMO; Mechanical circulatory support; pVAD.

Fig. 1

Incidence, survival of cardiogenic shock and mechanical circulatory support usage. a An increasing incidence (black) of reported cardiogenic shock in Germany is depicted from 2007 to 2017 with a low overall survival (white) at 40.2% and a very small increase of 2.1% over the last decade in total. b The increasing numbers of cases of cardiogenic shock in total (black) in Germany is presented from 2007 to 2017. Whereas the total number of cardiogenic shock and medically treated patients (green) is rising, the percentage of mechanical circulatory support (blue) is declining. c The number of patients who were assisted with different mechanical circulatory support (MCS) systems are displayed in Germany from 2007 to 2017, including the total number on MCS (blue), intraaortic balloon pump (IABP; white), percutaneous ventricular assist device (pVAD = Impella; violet) and veno-arterial extracorporeal membrane oxygenation (VA-ECMO; green). The sharp decline in IABP usage in 2013 is followed by a decrease in the total usage. In the year 2013, pVAD and VA-ECMO therapies started rising and provide for an increase in total MCS usage until 2017. Nevertheless, IABP remained more frequent until 2015. Afterwards VA-ECMO therapy takes over as most common device. d The usage of different MCS devices result in different hospital survival rates in Germany from 2007 to 2017. Hospital survival of patients on VA-ECMO (green) in cardiogenic shock is lowest, but rising steadily over the last years. It is followed by pVAD (violet) therapies. The application of IABP (white) therapy shows the best survival (even better than medical treatment only strategy; black)