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Management of Cardiogenic Shock

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (30 April 2020) | Viewed by 31717

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Special Issue Editor

Prof. Dr. Dirk Westermann

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Guest Editor

Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
Interests: cardiology; emergency medical aid

Special Issue Information

Dear Colleagues,

Cardiogenic shock (CS) remains a common cause of mortality. Despite recent advances in therapy, new options for treatment evolve slowly, and patients are in urgent need of a better understanding of CS’s pathophysiology to improve outcomes in the future.

It is in this context that the Journal of Clinical Medicine (Impact Factor 5.688) is launching a Special Issue "Cardiogenic Shock" to explore:

the epidemiology of CS;
the pathophysiology of CS;
the hemodynamic monitoring of CS;
the cardiopulmonary resuscitation (CPR) strategy in CS;
the medical therapy of CS;
the device (mechanical circulatory support) therapy of CS;
the percutaneous coronary intervention (PCI) strategies of CS;
possible therapies to increase heart recovery after CS; and
the ventricular assist device (VAD) therapy after survived CS.

This field is plagued by limited data. Therefore, we welcome research articles, debates, and reviews on all aspects of research into CS.

Prof. Dr. Dirk Westermann
Guest Editor

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Keywords

cardiogenic shock
hemodynamic monitoring
venoarterial extracorporeal membrane oxygenation (VA-ECMO)
ventricular assist device (VAD)
extracorporeal cardiopulmonary resuscitation (eCPR)

Published Papers (6 papers)

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Research

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12 pages, 1404 KiB

Open AccessArticle

Short- and Long-Term Mortality Trends in STEMI-Cardiogenic Shock over Three Decades (1989–2018): The Ruti-STEMI-Shock Registry

by Cosme García-García, Teresa Oliveras, Nabil El Ouaddi, Ferran Rueda, Jordi Serra, Carlos Labata, Marc Ferrer, German Cediel, Santiago Montero, Maria Jose Martínez, Helena Resta, Oriol de Diego, Joan Vila, Irene R Dégano, Roberto Elosua, Josep Lupón and Antoni Bayes-Genis

J. Clin. Med. 2020, 9(8), 2398; https://doi.org/10.3390/jcm9082398 - 27 Jul 2020

Cited by 15 | Viewed by 2260

Abstract

Aims: Cardiogenic shock (CS) is an ominous complication of ST-elevation myocardial infarction (STEMI), despite the recent widespread use of reperfusion and invasive management. The Ruti-STEMI-Shock registry analysed the prevalence of and 30-day and 1-year mortality rates in ST-elevation myocardial infarction (STEMI) complicated by CS (STEMI-CS) over the last three decades. Methods and Results: From February 1989 to December 2018, 493 STEMI-CS patients were consecutively admitted in a well-defined geographical area of ~850,000 inhabitants. Patients were classified into six five-year periods based on their year of admission. STEMI-CS mortality trends were analysed at 30 days and 1 year across the six strata. Cox regression analyses were performed for comparisons. Mean age was 67.5 ± 11.7 years; 69.4% were men. STEMI-CS prevalence did not decline from period 1 to 6 (7.1 vs. 6.2%, p = 0.218). Reperfusion therapy increased from 22.5% in 1989–1993 to 85.4% in 2014–2018. Thirty-day all-cause mortality declined from period 1 to 6 (65% vs. 50.5%, p < 0.001), with a 9% reduction after multivariable adjustment (HR: 0.91; 95% CI: 0.84–0.99; p = 0.024). One-year all-cause mortality declined from period 1 to 6 (67.5% vs. 57.3%, p = 0.001), with an 8% reduction after multivariable adjustment (HR: 0.92; 95% CI: 0.85–0.99; p = 0.030). Short- and long-term mortality trends in patients aged ≥ 75 years remained ~75%. Conclusions: Short- and long-term STEMI-CS-related mortality declined over the last 30 years, to ~50% of all patients. We have failed to achieve any mortality benefit in STEMI-CS patients over 75 years of age. Full article

(This article belongs to the Special Issue Management of Cardiogenic Shock)

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11 pages, 969 KiB

Open AccessArticle

Patient Characteristics, Treatment and Outcome in Non-Ischemic vs. Ischemic Cardiogenic Shock

by Benedikt Schrage, Jessica Weimann, Salim Dabboura, Isabell Yan, Rafel Hilal, Peter Moritz Becher, Moritz Seiffert, Alexander M. Bernhardt, Stefan Kluge, Hermann Reichenspurner, Stefan Blankenberg and Dirk Westermann

J. Clin. Med. 2020, 9(4), 931; https://doi.org/10.3390/jcm9040931 - 28 Mar 2020

Cited by 31 | Viewed by 3462

Abstract

Aim: Evidence on non-ischemic cardiogenic shock (CS) is scarce. The aim of this study was to investigate differences in patient characteristics, use of treatments and outcomes in patients with non-ischemic vs. ischemic CS. Methods: Patients with CS admitted between October 2009 and October 2017 were identified and stratified as non-ischemic/ischemic CS based on the absence/presence of acute myocardial infarction. Logistic/Cox regression models were fitted to investigate the association between non-ischemic CS and patient characteristics, use of treatments and 30-day in-hospital mortality. Results: A total of 978 patients were enrolled in this study; median age was 70 (interquartile range 58, 79) years and 70% were male. Of these, 505 patients (52%) had non-ischemic CS. Patients with non-ischemic CS were more likely to be younger and female; were less likely to be active smokers, to have diabetes or decreased renal function, but more likely to have a history of myocardial infarction; and they were more likely to present with unfavorable hemodynamics and with mechanical ventilation. Regarding treatments, patients with non-ischemic CS were more likely to be treated with catecholamines, but less likely to be treated with extracorporeal membrane oxygenation or percutaneous left-ventricular assist devices. After adjustment for multiple relevant confounders, non-ischemic CS was associated with a significant increase in the risk of 30-day in-hospital mortality (hazard ratio 1.14, 95% confidence interval 1.04–1.24, p < 0.01). Conclusion: In this large study, non-ischemic CS accounted for more than 50% of all CS cases. Non-ischemic CS was not only associated with relevant differences in patient characteristics and use of treatments, but also with a worse prognosis. These findings highlight the need for effective treatment strategies for patients with non-ischemic CS. Full article

(This article belongs to the Special Issue Management of Cardiogenic Shock)

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11 pages, 772 KiB

Open AccessArticle

Outcomes Associated with Respiratory Failure for Patients with Cardiogenic Shock and Acute Myocardial Infarction: A Substudy of the CULPRIT-SHOCK Trial

by Maria Rubini Giménez, P. Elliott Miller, Carlos L. Alviar, Sean van Diepen, Christopher B. Granger, Gilles Montalescot, Stephan Windecker, Lars Maier, Pranas Serpytis, Rokas Serpytis, Keith G. Oldroyd, Marko Noc, Georg Fuernau, Kurt Huber, Marcus Sandri, Suzanne de Waha-Thiele, Steffen Schneider, Taoufik Ouarrak, Uwe Zeymer, Steffen Desch and Holger Thiele Show full author list Hide full author list

J. Clin. Med. 2020, 9(3), 860; https://doi.org/10.3390/jcm9030860 - 20 Mar 2020

Cited by 13 | Viewed by 3599

Abstract

Background: Little is known about clinical outcomes of patients with acute myocardial infraction (AMI) complicated by cardiogenic shock (CS) requiring mechanical ventilation (MV). The aim of this study was to identify the characteristics, risk factors, and outcomes associated with the provision of MV in this specific high-risk population. Methods: Patients with CS complicating AMI and multivessel coronary artery disease from the CULPRIT-SHOCK trial were included. We explored 30 days of clinical outcomes in patients not requiring MV, those with MV on admission, and those in whom MV was initiated within the first day after admission. Results: Among 683 randomized patients included in the analysis, 17.4% received no MV, 59.7% were ventilated at admission and 22.8% received MV within or after the first day after admission. Patients requiring MV had a different risk-profile. Factors independently associated with the provision of MV on admission included higher body weight, resuscitation within 24 h before admission, elevated heart rate and evidence of triple vessel disease. Conclusions: Requiring MV in patients with CS complicating AMI is common and independently associated with mortality after adjusting for covariates. Patients with delayed MV initiation appear to be at higher risk of adverse outcomes. Further research is necessary to identify the optimal timing of MV in this high-risk population. Full article

(This article belongs to the Special Issue Management of Cardiogenic Shock)

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10 pages, 711 KiB

Open AccessArticle

Prognostic Significance of Arterial Lactate Levels at Weaning from Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation

by Fausto Biancari, Antonio Fiore, Kristján Jónsson, Giuseppe Gatti, Svante Zipfel, Vito G. Ruggieri, Andrea Perrotti, Karl Bounader, Antonio Loforte, Andrea Lechiancole, Diyar Saeed, Artur Lichtenberg, Marek Pol, Cristiano Spadaccio, Matteo Pettinari, Krister Mogianos, Khalid Alkhamees, Giovanni Mariscalco, Zein El Dean, Nicla Settembre, Henryk Welp, Angelo M. Dell’Aquila, Thomas Fux, Tatu Juvonen and Magnus Dalén Show full author list Hide full author list

J. Clin. Med. 2019, 8(12), 2218; https://doi.org/10.3390/jcm8122218 - 15 Dec 2019

Cited by 14 | Viewed by 2930

Abstract

Background: The outcome after weaning from postcardiotomy venoarterial extracorporeal membrane oxygenation (VA-ECMO) is poor. In this study, we investigated the prognostic impact of arterial lactate levels at the time of weaning from postcardiotomy VA. Methods: This analysis included 338 patients from the multicenter PC-ECMO registry with available data on arterial lactate levels at weaning from VA-ECMO. Results: Arterial lactate levels at weaning from VA-ECMO (adjusted OR 1.426, 95%CI 1.157–1.758) was an independent predictor of hospital mortality, and its best cutoff values was 1.6 mmol/L (<1.6 mmol/L, 26.2% vs. ≥ 1.6 mmol/L, 45.0%; adjusted OR 2.489, 95%CI 1.374–4.505). When 261 patients with arterial lactate at VA-ECMO weaning ≤2.0 mmol/L were analyzed, a cutoff of arterial lactate of 1.4 mmol/L for prediction of hospital mortality was identified (<1.4 mmol/L, 24.2% vs. ≥1.4 mmol/L, 38.5%, p = 0.014). Among 87 propensity score-matched pairs, hospital mortality was significantly higher in patients with arterial lactate ≥1.4 mmol/L (39.1% vs. 23.0%, p = 0.029) compared to those with lower arterial lactate. Conclusions: Increased arterial lactate levels at the time of weaning from postcardiotomy VA-ECMO increases significantly the risk of hospital mortality. Arterial lactate may be useful in guiding optimal timing of VA-ECMO weaning. Full article

(This article belongs to the Special Issue Management of Cardiogenic Shock)

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Review

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36 pages, 6278 KiB

Open AccessFeature PaperReview

Left Ventricle Unloading with Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock. Systematic Review and Meta-Analysis

by Mariusz Kowalewski, Pietro Giorgio Malvindi, Kamil Zieliński, Gennaro Martucci, Artur Słomka, Piotr Suwalski, Roberto Lorusso, Paolo Meani, Antonio Arcadipane, Michele Pilato and Giuseppe Maria Raffa

J. Clin. Med. 2020, 9(4), 1039; https://doi.org/10.3390/jcm9041039 - 7 Apr 2020

Cited by 33 | Viewed by 10319

Abstract

During veno-arterial extracorporeal membrane oxygenation (VA-ECMO), the increase of left ventricular (LV) afterload can potentially increase the LV stress, exacerbate myocardial ischemia and delay recovery from cardiogenic shock (CS). Several strategies of LV unloading have been proposed. Systematic review and meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement included adult patients from studies published between January 2000 and March 2019. The search was conducted through numerous databases. Overall, from 62 papers, 7581 patients were included, among whom 3337 (44.0%) received LV unloading concomitant to VA-ECMO. Overall, in-hospital mortality was 58.9% (4466/7581). A concomitant strategy of LV unloading as compared to ECMO alone was associated with 12% lower mortality risk (RR 0.88; 95% CI 0.82–0.93; p < 0.0001; I² = 40%) and 35% higher probability of weaning from ECMO (RR 1.35; 95% CI 1.21–1.51; p < 0.00001; I² = 38%). In an analysis stratified by setting, the highest mortality risk benefit was observed in case of acute myocardial infarction: RR 0.75; 95%CI 0.68–0.83; p < 0.0001; I² = 0%. There were no apparent differences between two techniques in terms of complications. In heterogeneous populations of critically ill adults in CS and supported with VA-ECMO, the adjunct of LV unloading is associated with lower early mortality and higher rate of weaning. Full article

(This article belongs to the Special Issue Management of Cardiogenic Shock)

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17 pages, 1708 KiB

Open AccessReview

Update on Weaning from Veno-Arterial Extracorporeal Membrane Oxygenation

by Enzo Lüsebrink, Christopher Stremmel, Konstantin Stark, Dominik Joskowiak, Thomas Czermak, Frank Born, Danny Kupka, Clemens Scherer, Mathias Orban, Tobias Petzold, Patrick von Samson-Himmelstjerna, Stefan Kääb, Christian Hagl, Steffen Massberg, Sven Peterss and Martin Orban

J. Clin. Med. 2020, 9(4), 992; https://doi.org/10.3390/jcm9040992 - 2 Apr 2020

Cited by 50 | Viewed by 8229

Abstract

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides temporary cardiac and respiratory support and has emerged as an established salvage intervention for patients with hemodynamic compromise or shock. It is thereby used as a bridge to recovery, bridge to permanent ventricular assist devices, bridge to transplantation, or bridge to decision. However, weaning from VA-ECMO differs between centers, and information about standardized weaning protocols are rare. Given the high mortality of patients undergoing VA-ECMO treatment, it is all the more important to answer the many questions still remaining unresolved in this field Standardized algorithms are recommended to optimize the weaning process and determine whether the VA-ECMO can be safely removed. Successful weaning as a multifactorial process requires sufficient recovery of myocardial and end-organ function. The patient should be considered hemodynamically stable, although left ventricular function often remains impaired during and after weaning. Echocardiographic and invasive hemodynamic monitoring seem to be indispensable when evaluating biventricular recovery and in determining whether the VA-ECMO can be weaned successfully or not, whereas cardiac biomarkers may not be useful in stratifying those who will recover. This review summarizes the strategies of weaning of VA-ECMO and discusses predictors of successful and poor weaning outcome. Full article

(This article belongs to the Special Issue Management of Cardiogenic Shock)

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