Outcome of the impella device for acute mechanical circulatory support.

OBJECTIVE: The contribution of cardiogenic shock to in-hospital mortality has not decreased significantly despite prompt revascularization, advances in medical therapy, and mechanical circulatory support. For patients in cardiogenic shock, mechanical circulatory support has been provided by a variety of devices. We report the outcome of the Impella device for acute mechanical circulatory support in cardiogenic shock in a setting of a large-volume single institution. The primary end points include survival to 30 days and recovery of native heart function and survival to 90 days and 1 year. The secondary end points include device complications. METHODS: We performed a retrospective chart review of 36 consecutive patients who underwent placement of the Impella device from February 6, 2006, to December 31, 2010. The charts were evaluated for data relative to the patients' demographics, hemodynamics, operative details, 30-day outcome including the patients' native heart function recovery, and 90-day and 1-year survival. RESULTS: Thirty-six consecutive patients were included in our study. The mean ± SD age was 60.3 ± 13 years, and 69% were men. The indication for placement of the Impella device included postcardiotomy cardiogenic shock in 23 patients (64%), acute myocardial infarction complicated with cardiogenic shock in 10 patients (28%), acute decompensated ischemic cardiomyopathy in 2 patients (6%), and myocarditis with cardiogenic shock in 1 patient (3%). The mean ± SD duration of the Impella support was 4.5 ± 3.9 days (range, 1-18). The 30-day survival rate was 72% (26/36), and, of those, 96% (25/26) recovered their native heart function and one (4%) was bridged to long-term left ventricular assist device (HeartMate II; Thoratec, Inc, Pleasanton, CA USA). The 90-day and 1-year survival was 64% and 61%, respectively. CONCLUSIONS: The Impella devices yielded a very favorable outcome in patients with cardiogenic shock.

Supporting the Global War on Terror: a tale of two campaigns featuring the 250th Forward Surgical Team (Airborne).

BACKGROUND: Forward Surgical Teams (FSTs) are 20-person units designed to perform front-line, life-saving combat surgery. This study compares the employment, injuries encountered, and workload of an airborne FST in two widely varying campaigns. METHODS: The 250th FST provided far forward surgery for initial entry assaults and follow-on stability operations in Afghanistan (Operation Enduring Freedom [OEF]) and northern Iraq (Operation Iraqi Freedom [OIF]). Prospective data on all patients admitted to the 250th were analyzed. Data from civil affairs missions were evaluated retrospectively. RESULTS: In supporting combat operations, 127 surgical procedures (OEF: 68, OIF: 59) were performed on 98 patients (OEF: 50, OIF: 48) during 17 months deployed (OEF: 6, OIF: 11). After initial assaults, stability actions varied significantly in terms of civil affairs missions (OEF: 3, OIF: 161). CONCLUSIONS: Although the number and types of combat casualties were similar between the campaigns, employment of the FST changed dramatically in OIF because of increased medical reconstruction missions.