Acute cardiac care & resuscitation
Relationship between the volume of cases and in-hospital mortality in patients with cardiogenic shock receiving short-term mechanical circulatory support
Authors' conclusion
Higher volumes of IABP and ECMO are associated with a lower mortality. There is an upper limit to the decline.
Study context
- Population
- Patients with cardiogenic shock receiving short-term mechanical circulatory support (MCS), Japan, April 2012–March 20203 subcohorts of 65,837 patients
- Participants
- 48,643 / 16,871 / 696
- Exposure
- Higher vs lower annual hospital case volume
- Intra-aortic balloon pump (IABP) alonen = 48,643
- Extracorporeal membrane oxygenation (ECMO)n = 16,871
- Impellan = 696
- Outcome
- In-hospital mortality
Methodological detailsJapanese nationwide database
- Japanese nationwide database
Main finding
As reported in the abstract
In-hospital mortality by annual case volume
IABP alone
- Mortality quintile 1
- 25.1%
- Mortality quintile 5
- 15.2%
ECMO
- Mortality quintile 1
- 73.7%
- Mortality quintile 5
- 67.4%
Mortality quintile 1
IABP alone25.1%
ECMO73.7%
Mortality quintile 5
IABP alone15.2%
ECMO67.4%
Adjusted odds ratio (CI)
IABP alone quintile 5 vs IABP alone quintile 1
0.63(0.58–0.68)
ECMO quintile 5 vs ECMO quintile 1
0.73(0.65–0.82)
Impella tertile 3 vs Impella tertile 1
0.90(0.58–1.39)
Observational data: associations, not effects.
Further findings
Median
| Outcome | IABP alone | ECMO | Impella |
|---|---|---|---|
| Median annual case volumeSpread type not named in abstract | 13.5 (range 7.4–22.1) | 6.4 (range 3.4–11.0) | 7.5 (range 4.0–10.7) |
Original publication
Relationship between the volume of cases and in-hospital mortality in patients with cardiogenic shock receiving short-term mechanical circulatory support. Am Heart J. Published 7 April 2023. doi:10.
Summarised from the published abstract; every number is checked against it