Infections following temporary mechanical circulatory support in cardiogenic shock: Incidence, associations, and...

Infection complicates temporary mechanical circulatory support (tMCS) in cardiogenic shock (CS), but the contributions of device, severity, and timing remain unclear.

Adults with CS supported by Impella, venoarterial extracorporeal membrane oxygenation (VA-ECMO), or both (ECPELLA) at a quaternary center (2021-2025) were studied retrospectively. Infection required clinician diagnosis, positive culture, and ≥5 days of targeted therapy. Cause-specific Cox and Fine-Gray competing-risks models assessed infection and a separate Cox model assessed 60-day mortality with infection as a time-varying covariate.

Among 297 patients, 111 (37.4%) developed a post-tMCS infection. Most first infections (75.7%) occurred within 14 days, with week-1 incidence over twice the average. Infected patients had longer hospital stays (35 vs 19 days, p < 0.001) and were less often discharged home (13.5% vs 31.2%, p < 0.001) but had similar in-hospital mortality (37.8% vs 37.6%, p = 0.972). Relative to Impella use alone, VA-ECMO use alone (cause-specific HR 2.70, 95% CI 1.63-4.48, p < 0.001) and ECPELLA use (HR 1.79, 95% CI 1.10-2.93, p = 0.020) were independently associated with infection (concordant on Fine-Gray analysis). Older age (HR 1.03/year, 95% CI 1.02-1.05, p < 0.001) and higher lactate at tMCS placement (HR 1.08 per mmol/L, 1.04-1.12, p < 0.001) were independently associated with 60-day mortality, while infection was not.

Infection affected more than one-third of CS-tMCS patients, with peak risk in the first week. VA-ECMO support carried higher infection risk. Sixty-day mortality tracked older age and lactate at tMCS placement, but not device type. Infection was not associated with increased mortality but was associated with longer hospitalization and worse discharge disposition.