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Cardiogenic Shock and Cardiac Arrest: Updates, Challenges and Opportunities

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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: 25 January 2027 | Viewed by 8914

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Dr. Torben K. Becker

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Department of Emergency Medicine, Division of Critical Care Medicine, University of Florida College of Medicine, Gainesville, FL 32610, USA
Interests: cardiac arrest; extracorporeal membrane oxygenation; extracorporeal CPR; cardiopulmonary resuscitation; cardiogenic shock
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Special Issue Information

Dear Colleagues,

Cardiac arrest remains a leading global cause of mortality and morbidity, with survival rates stagnating despite advancements in resuscitation science. This Special Issue explores the multifaceted nature of cardiac arrest and the critical need for innovation and scientific advances to improve outcomes.

Cardiac arrest is not a singular event but a complex interplay of pathophysiological mechanisms, patient-specific variables, and system-level factors. Its treatment requires an interdisciplinary approach, integrating expertise from a wide array of clinical specialties and health systems science. Novel therapies, such as extracorporeal cardiopulmonary resuscitation (ECPR), offer promising avenues for improving outcomes in select populations, yet their implementation demands rigorous scientific validation and resource-intensive infrastructure.

This Issue seeks to emphasize gaps in understanding cardiac arrest physiology, including the roles of microcirculatory dysfunction, metabolic derangements, and neurological injury. Contributions highlighting emerging technologies, from precision-targeted interventions to advanced monitoring tools, such as potential game-changers in personalizing care, are welcome.

Dr. Torben K. Becker
Guest Editor

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Keywords

cardiac arrest
extracorporeal membrane oxygenation
extracorporeal CPR
cardiopulmonary resuscitation
cardiogenic shock
resuscitation
prognostication

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Published Papers (5 papers)

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12 pages, 658 KB

Open AccessArticle

Continuous Compressions, Incomplete Ventilation? A Retrospective Analysis of mCPR in Admitted ED Patients

by Ingo Voigt, Mehran Babady, Katharina Schütte-Nütgen, Raimund Grondstein and Oliver Bruder

J. Clin. Med. 2026, 15(3), 933; https://doi.org/10.3390/jcm15030933 - 23 Jan 2026

Viewed by 1018

Abstract

Background/Objectives: Mechanical cardiopulmonary resuscitation (mCPR) devices offer consistent chest compressions during prolonged resuscitations and transport, but their impact on ventilation and patient outcomes remains unclear. This study aimed to compare gas exchange, metabolic parameters, and clinical outcomes in patients with ongoing manual versus mechanical CPR upon arrival at the emergency department (ED) after out-of-hospital cardiac arrest (OHCA). Methods: We conducted a retrospective analysis of 394 consecutive adult patients with non-traumatic OHCA admitted to a metropolitan cardiac arrest center between January 2019 and December 2024. Patients were categorized into three groups: Return of spontaneous circulation (ROSC) on arrival (n = 240), ongoing manual CPR (n = 107), and ongoing mechanical CPR (n = 47). Gas exchange and metabolic parameters were obtained from initial arterial blood gas (ABG) analysis and monitor readings. The primary outcome was survival to hospital discharge; secondary outcomes included 24 h survival and neurological status at discharge (CPC 1–2). Results: Survival to hospital discharge was significantly higher in the manual CPR group (8.4%) compared to 0% in the mechanical CPR group (p = 0.04). Both groups showed severe acidosis and hypercapnia upon ED arrival; however, PaCO₂ levels were significantly higher in the mCPR group (83.0 ± 25.5 mmHg vs. 72.3 ± 21.6 mmHg, p = 0.01). ROC analysis identified lactate (AUC = 0.765) and pH (AUC = 0.743) as the strongest predictors of survival, while EtCO₂ had limited prognostic value (AUC = 0.541). Conclusions: In patients with refractory out-of-hospital cardiac arrest admitted with ongoing cardiopulmonary resuscitation, mechanical CPR was associated with higher PaCO₂ levels on emergency department arrival compared with manual CPR, while other gas exchange parameters did not differ significantly. Given the limited sample size and small number of survivors, these findings are exploratory and hypothesis-generating, underscoring the need for prospective studies on ventilation during continuous chest compressions. Full article

(This article belongs to the Special Issue Cardiogenic Shock and Cardiac Arrest: Updates, Challenges and Opportunities)

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16 pages, 512 KB

Open AccessArticle

Impact of a 9-1-1-Integrated Mobile App on Bystander CPR: Implementation of PulsePoint in an Urban County

by Charles W. Hwang, Anthony J. Meyer, Ira Harmon, Brandon P. Climenhage, Eric M. Nordhues and Torben K. Becker

J. Clin. Med. 2026, 15(1), 5; https://doi.org/10.3390/jcm15010005 - 19 Dec 2025

Viewed by 1590

Abstract

Background/Objectives: Early bystander CPR helps to restore perfusion and improves the likelihood of favorable survival and neurological outcome after out-of-hospital cardiac arrest (OHCA). One strategy to improve bystander CPR is the use of crowd-sourcing mobile CPR applications such as PulsePoint, which notifies bystanders of nearby OHCA. In 2019, PulsePoint was deployed in an urban county. Prior to its deployment, bystander CPR rates were 42.9% in this county. This descriptive analysis seeks to analyze bystander intervention after PulsePoint implementation in an urban county. Methods: This retrospective observational study included all PulsePoint activations in Alachua County from June 2020 to September 2023. Patient characteristics and survey data were extracted from EMS patient care reports, hospital electronic medical records, and Pulsepoint dispatch and responder data. Descriptive statistics were used to analyze patient and responder characteristics, PulsePoint activation circumstances, and patient care. Results: Of 225 PulsePoint activations, 95 (42.2%) were confirmed OHCA. Among these, 54 (56.8%) received bystander CPR prior to EMS arrival. Out of 15 prehospital defibrillations, laypersons defibrillated 9 patients (60.0%). There was an average of 3.3 eligible PulsePoint responders within a 0.25-mile radius of the OHCA victim. A majority of PulsePoint survey respondents were formally trained in CPR and automated defibrillator use. Conclusions: The data from our urban EMS experience demonstrate that bystander CPR rates were higher after PulsePoint deployment (56.8%) than before. Our bystander CPR rate was also higher than the national average. Full article

(This article belongs to the Special Issue Cardiogenic Shock and Cardiac Arrest: Updates, Challenges and Opportunities)

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9 pages, 227 KB

Open AccessArticle

In Cardiogenic Shock, Overweight and Obesity Have the Lowest, Whereas Cachexia Has the Highest Mortality

by Mohammad Reza Movahed, Mehrdad Mahalleh, Zahra Sadin and Mehrtash Hashemzadeh

J. Clin. Med. 2025, 14(15), 5275; https://doi.org/10.3390/jcm14155275 - 25 Jul 2025

Cited by 2 | Viewed by 1088

Abstract

Introduction: The obesity paradox has been observed in patients with cardiovascular disease. The goal of this study was to evaluate whether obesity has a protective effect in patients presenting with cardiogenic shock. Method: Using a large Nationwide Inpatient (NIS) sample database, we evaluated mortality in patients with cardiogenic shock based on weight categories in adults. Results: A total of 843,020 patients over age 18 had a diagnosis of cardiogenic shock in the database. We found that overweight and obesity had the lowest mortality using univariate or multivariate analysis (overweight mortality of 20.66% vs. obesity mortality of 26.6% vs. 34.8% of normal weights). In contrast, cachexia was associated with the highest mortality in univariate analysis (cachexia 40.4%). Using multivariate analysis adjusting for age, baseline characteristics, and comorbidities, these relations remained unchanged (cachexia MVOR: 1.13; CI: 1.21–1.13; p < 0.001; overweight MVOR: 0.52, CI: 0.43–0.65; p < 0.001; obesity MVOR: 0.76, CI: 0.73–0.79; p < 0.001). After multivariate adjustment, morbid obesity had similar mortality to patients with normal weight (morbid obesity MVOR: 0.99 CI 0.95–01.03; p = 0.6) Conclusions: We observe a partial obesity paradox in patients with cardiogenic shock, showing that being overweight, followed by obesity, has the lowest mortality, whereas cachexia has the highest mortality despite multivariate adjustment. Full article

(This article belongs to the Special Issue Cardiogenic Shock and Cardiac Arrest: Updates, Challenges and Opportunities)

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6 pages, 5163 KB

Open AccessCase Report

Pseudoaneurysmectomy After Left Ventricular Free Wall Rupture Repair: A Case Report

by B. Ufuk Baldan, Patrick Klein, J. Lauran Stöger, Robert J. M. Klautz and Meindert Palmen

J. Clin. Med. 2025, 14(10), 3393; https://doi.org/10.3390/jcm14103393 - 13 May 2025

Viewed by 1234

Abstract

Background/Objectives: Left ventricular (LV) pseudoaneurysm is a rare but life-threatening complication after acute myocardial infarction, often resulting from inadequate excision of damaged myocardium and use of only a xenopericardial patch during primary LV free wall rupture repair. Methods: A 62-year-old female developed a giant LV pseudoaneurysm one year after initial surgical repair of a free wall rupture with a xenopericardial patch. Imaging confirmed a large pseudoaneurysm with a broad neck and mural thrombus. She underwent pseudoaneurysmectomy, LV reconstruction with a Dacron patch overlaid by a xenopericardial patch, and concomitant mitral and tricuspid valve repair. Results: Surgical exploration revealed a broad-necked pseudoaneurysm and dehisced patch material. The aneurysm was resected, and the LV was reconstructed, resulting in the exclusion of the pseudoaneurysm and improvement of the shape and function. The patient recovered uneventfully and was discharged in good clinical condition with restored LV function. Conclusions: Pseudoaneurysm formation after LV free wall rupture repair is often due to insufficient resection and the use of only a xenopericardial patch. Surgical management with complete excision, Dacron patch reconstruction, and xenopericardial reinforcement facilitates the favorable remodeling of LV geometry and function, and reduces the risk of recurrence. Full article

(This article belongs to the Special Issue Cardiogenic Shock and Cardiac Arrest: Updates, Challenges and Opportunities)

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24 pages, 1103 KB

Open AccessEditor’s ChoiceSystematic Review

Lactate and pH as Independent Biomarkers for Prognosticating Meaningful Post-out-of-Hospital Cardiac Arrest Outcomes: A Systematic Review and Meta-Analysis

by Nishil T. Patel, Casey T. Carr, Charlotte M. Hopson and Charles W. Hwang

J. Clin. Med. 2025, 14(7), 2244; https://doi.org/10.3390/jcm14072244 - 25 Mar 2025

Cited by 9 | Viewed by 3070

Abstract

Background/Objectives: To systematically review the literature and to characterize the utility of lactate and pH for predicting survival and long-term neurological outcomes after out-of-hospital cardiac arrest (OHCA). Methods: PRISMA guidelines were followed. PubMed, Embase, Web of Science, Cochrane Central, and Academic Search Premier were searched for relevant studies. The population included adults with OHCA. Studies with majority in-hospital cardiac arrest (>50%) and studies predicting return of spontaneous circulation (ROSC) were excluded. Pairs of investigators reviewed the studies for relevance. Data were extracted and risk of bias was assessed using the Newcastle–Ottawa Scale. Meta-analyses were performed to characterize the relationship between lactate and pH with survival and neurological outcomes. Results: We included 21,120 patients over 49 studies. Most studies (78%) included OHCA only. Mean lactate of 7.24 (95%CI:6.05–8.44) was associated with favorable survival (n = 9155; 21 studies), while mean lactate of 7.15 (95%CI:6.37–7.93) was associated with favorable neurological outcome (n = 7534; 21 studies). Mean pH of 7.22 (95%CI:7.10–7.33) was associated with favorable survival (n = 4077; 7 studies), while a mean pH of 7.22 (95%CI:7.17–7.27) was associated with favorable neurological outcome (n = 6701; 13 studies). Poor outcomes were associated with lower pH and higher lactate values. Risk of bias was generally low to medium, while heterogeneity was high. Conclusions: A direct correlation exists between pH with survival and neurological outcome; the likelihood of favorable outcomes increases as pH increases. Conversely, an inverse relationship exists between lactate with survival and neurological outcome; higher lactate is associated with poorer outcomes. For lactate, the threshold for survival was more lenient than for favorable neurological outcome. Full article

(This article belongs to the Special Issue Cardiogenic Shock and Cardiac Arrest: Updates, Challenges and Opportunities)

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