{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T14:40:21Z","timestamp":1784990421331,"version":"3.55.0"},"reference-count":15,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2021,2,26]],"date-time":"2021-02-26T00:00:00Z","timestamp":1614297600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Critically ill patients with cardiogenic shock could benefit from ventricular assist device support using the Impella microaxial blood pump. However, recent studies suggested Impella not to improve outcomes. We, therefore, evaluated outcomes and predictors in a real-world scenario.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>In this retrospective single-center trial, 125 patients suffering from cardiac arrest\/cardiogenic shock between 2008 and 2018 were analyzed. 93 Patients had a prior successful cardiopulmonary resuscitation. The primary endpoint was hospital mortality. Associations of covariates with the primary endpoint were assessed by univariable and multivariable logistic regression. Adjusted odds ratios (aOR) and optimal cut-offs (using Youden index) were obtained.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Hospital mortality was high (81%). Baseline lactate was 4.7mmol\/L [IQR = 7.1mmol\/L]. In multivariable logistic regression, only age (aOR 1.13 95%CI 1.06\u20131.20; p&lt;0.001) and lactate (aOR 1.23 95%CI 1.004\u20131.516; p = 0.046) were associated with hospital mortality, and the respective optimal cut-offs were &gt;3.3mmol\/L and age &gt;66 years.<\/jats:p>\n<jats:p>Patients were retrospectively stratified into three risk groups: Patients aged \u226466 years and lactate \u22643.3mmol (low-risk; n = 22); patients aged &gt;66 years or lactate &gt;3.3mmol\/L (medium-risk; n = 52); and patients both aged &gt;66 years and lactate &gt;3.3mmol\/L (high-risk, n = 51). Risk of death increased from 41% in the low-risk group, to 79% in the medium risk group and 100% in the high-risk group. The predictive abilities of this model were high (AUC 0.84; 95% 0.77\u20130.92).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Mortality was high in this real-world collective of severely ill cardiogenic shock patients. Better patient selection is warranted to avoid unethical use of Impella. Age and lactate might help to improve patient selection.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0247667","type":"journal-article","created":{"date-parts":[[2021,2,26]],"date-time":"2021-02-26T18:27:39Z","timestamp":1614364059000},"page":"e0247667","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Impella use in real-world cardiogenic shock patients: Sobering outcomes"],"prefix":"10.1371","volume":"16","author":[{"given":"Khaled Q. A.","family":"Abdullah","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jana V.","family":"Roedler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juergen","family":"vom Dahl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Istvan","family":"Szendey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hendrik","family":"Haake","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Eckardt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert","family":"Topf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Ohnewein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Jirak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas J.","family":"Motloch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Wernly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1413-5152","authenticated-orcid":true,"given":"Robert","family":"Larbig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,2,26]]},"reference":[{"key":"pone.0247667.ref001","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1016\/j.ijcard.2015.07.065","article-title":"Impella ventricular support in clinical practice: Collaborative viewpoint from a European expert user group","volume":"201","author":"F Burzotta","year":"2015","journal-title":"Int J Cardiol"},{"key":"pone.0247667.ref002","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1080\/17434440.2018.1456334","article-title":"Overview of 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shock","volume":"219","author":"K Lackermair","year":"2016","journal-title":"Int J Cardiol"},{"key":"pone.0247667.ref006","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1080\/17434440.2017.1374849","article-title":"Utilization of the Impella for hemodynamic support during percutaneous intervention and cardiogenic shock: an insight","volume":"14","author":"N Nalluri","year":"2017","journal-title":"Expert Rev Med Devices"},{"key":"pone.0247667.ref007","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/j.jvs.2015.03.040","article-title":"Incidence and prognosis of vascular complications after percutaneous placement of left ventricular assist device","volume":"62","author":"M Abaunza","year":"2015","journal-title":"J Vasc Surg"},{"key":"pone.0247667.ref008","article-title":"Association of Use of an Intravascular Microaxial Left Ventricular Assist Device vs Intra-aortic Balloon Pump With In-Hospital Mortality and Major Bleeding Among Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock","author":"SS Dhruva","year":"2020","journal-title":"JAMA"},{"key":"pone.0247667.ref009","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/j.amjcard.2019.05.039","article-title":"Predictors of Mortality and Outcomes of Acute Severe Cardiogenic Shock Treated with the Impella Device","volume":"124","author":"CL Rohm","year":"2019","journal-title":"Am J Cardiol"},{"key":"pone.0247667.ref010","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1161\/CIRCHEARTFAILURE.112.967224","article-title":"Percutaneous left-ventricular support with the Impella-2.5-assist device in acute cardiogenic shock: results of the Impella-EUROSHOCK-registry","volume":"6","author":"A Lauten","year":"2013","journal-title":"Circ Heart Fail"},{"key":"pone.0247667.ref011","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1007\/s00134-018-5475-3","article-title":"Prognostic relevance of serum lactate kinetics in critically ill patients","volume":"45","author":"M Masyuk","year":"2019","journal-title":"Intensive Care Med"},{"key":"pone.0247667.ref012","doi-asserted-by":"crossref","DOI":"10.3390\/ijms18091893","article-title":"The Lactate\/Albumin Ratio: A Valuable Tool for Risk Stratification in Septic Patients Admitted to ICU","volume":"18","author":"M Lichtenauer","year":"2017","journal-title":"Int J Mol Sci"},{"key":"pone.0247667.ref013","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1016\/j.jacc.2016.10.022","article-title":"Percutaneous Mechanical Circulatory Support Versus Intra-Aortic Balloon Pump in Cardiogenic Shock After Acute Myocardial Infarction","volume":"69","author":"DM Ouweneel","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"pone.0247667.ref014","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.jcrc.2017.06.022","article-title":"Lactate and lactate clearance as valuable tool to evaluate ECMO therapy in cardiogenic shock","volume":"42","author":"I Slottosch","year":"2017","journal-title":"J Crit Care"},{"key":"pone.0247667.ref015","doi-asserted-by":"crossref","DOI":"10.3390\/jcm8030374","article-title":"Lactate Clearance Predicts Good Neurological Outcomes in Cardiac Arrest Patients Treated with Extracorporeal Cardiopulmonary Resuscitation","volume":"8","author":"C Jung","year":"2019","journal-title":"J Clin Med"}],"container-title":["PLOS 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