| PMC full text: | Published online 2024 Apr 2. doi: 10.1186/s13054-024-04884-5
|
Table 2
Escalation to tMCS in HF-CS
| Statements | Median | Disagreement index (DI) | Inter-percentile range (IPR) | RAND panel outcome |
|---|---|---|---|---|
| Regarding the use of clinical, biochemical and haemodynamic parameters to guide escalation to tMCS in the context of maximal or optimal pharmacotherapy, please rate the appropriateness of the following: | ||||
| Failure to achieve adequate diuresis/clinical decongestion | 7.5 | 0.16 | 1.25 | Appropriate |
| Lactate clearance | 8.0 | 0.07 | 1.25 | Appropriate |
| Serial worsening of liver function tests (bilirubin, transaminases & INR) | 7.5 | 0.16 | 1.25 | Appropriate |
| Serial worsening of renal function (urine output, creatinine, eGFR) | 7.0 | 0.26 | 2.00 | Appropriate |
| Serial worsening of central venous oxygen saturations (ScVO2) | 7.0 | 0.26 | 2.00 | Appropriate |
| PAC haemodynamic data to inform escalation decisions | 7.5 | 0.43 | 3.00 | Appropriate |
| PAC haemodynamic data to inform device selection | 8.0 | 0.23 | 2.25 | Appropriate |
| Specific PAC thresholds (informed by AHA guidance [41], Geller et al. [42]) to inform escalation decisions | 4.5 | 0.55 | 2.25 | Uncertain |
| Echocardiographic parameters to guide escalation decisions | 6 | 0.43 | 2.25 | Uncertain |
| Echocardiographic parameters to guide device selection | 7 | 0.37 | 2.25 | Appropriate |
| Regarding the selection of tMCS in the management of SCAI Stage C HF-CS, please rate the appropriateness of the following: | ||||
| IABP as a tMCS option for bridge to recovery or durable therapies | 5.5 | 0.71 | 3.00 | Uncertain |
| Impella™ CP as a tMCS option for bridge to recovery or candidacy for durable HF therapies | 5.0 | 0.55 | 2.25 | Uncertain |
| Impella™ 5.0/5.5 as a tMCS option for bridge to recovery or candidacy for AHF therapies | 7.0 | 0.21 | 1.25 | Appropriate |
| Routine mechanical LV decompression in the context of peripheral VA ECMO | 6.5 | 0.59 | 3.25 | Appropriate |
| Optimised pharmacological LV decompression prior to mechanical LV decompression | 7.0 | 0.37 | 2.00 | Appropriate |
| IABP as a mechanical LV decompression strategy in peripheral V-A ECMO | 5.5 | 0.32 | 1.25 | Uncertain |
| Impella™ (CP/5.0/5.5) as a mechanical LV decompression strategy in peripheral V-A ECMO | 6.5 | 0.30 | 2.00 | Appropriate |
For each question, median scores were allocated as inappropriate if scoring <3.5, uncertain if ≥3.5 and <6.5 uncertain and appropriate if ≥6.5. DI was calculated using the RAND DI and disagreement deemed if DI ≥1 amongst the panellists.
AHA, American Heart Association; AHF, Advanced Heart Failure; eGFR, estimated Glomerular Filtration Rate; HF, Heart Failure; HF-CS, Heart Failure related Cardiogenic Shock; IABP, Intra-aortic Balloon Pump; Impella™ CP, Impella™ Central Pump; INR, International Normalised Ratio; LV, Left Ventricle; PAC, Pulmonary Artery Catheterisation; SCAI, Society for Cardiovascular Angiography and Interventions; ScVO2, Systemic Central Venous Oxygen Levels; tMCS, temporary Mechanical Circulatory Support; V-A ECMO, Venoarterial Extracorporeal Membrane Oxygenation