Position Statement on Vascular Access Safety for Percutaneous Devices in AMI Complicated by Cardiogenic Shock

Abdulla A. Damluji, Behnam Tehrani, Shashank S. Sinha, Marc D. Samsky, Timothy D. Henry, Holger Thiele, Nick E.J. West, Fortunato F. Senatore, Alexander G. Truesdell, George D. Dangas, Nathaniel R. Smilowitz, Amit P. Amin, Adam D. deVore, Nader Moazami, Joaquin E. Cigarroa, Sunil V. Rao, Mitchell W. Krucoff, David A. Morrow, Ian C. Gilchrist

    Research output: Contribution to journalReview articlepeer-review

    Abstract

    In the United States, the frequency of using percutaneous mechanical circulatory support devices for acute myocardial infarction complicated by cardiogenic shock is increasing. These devices require large-bore vascular access to provide left, right, or biventricular cardiac support, frequently under urgent/emergent circumstances. Significant technical and logistical variability exists in device insertion, care, and removal in the cardiac catheterization laboratory and in the cardiac intensive care unit. This variability in practice may contribute to adverse outcomes observed in centers that receive patients with cardiogenic shock, who are at higher risk for circulatory insufficiency, venous stasis, bleeding, and arterial hypoperfusion. In this position statement, we aim to: 1) describe the public health impact of bleeding and vascular complications in cardiogenic shock; 2) highlight knowledge gaps for vascular safety and provide a roadmap for a regulatory perspective necessary for advancing the field; 3) propose a minimum core set of process elements, or “vascular safety bundle”; and 4) develop a possible study design for a pragmatic trial platform to evaluate which structured approach to vascular access drives most benefit and prevents vascular and bleeding complications in practice.

    Original languageEnglish (US)
    Pages (from-to)2003-2019
    Number of pages17
    JournalJACC: Cardiovascular Interventions
    Volume15
    Issue number20
    DOIs
    StatePublished - Oct 24 2022

    Keywords

    • cardiogenic
    • complications
    • myocardial infarction
    • shock
    • vascular access devices

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine

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