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Cardiogenic Shock: 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: closed (30 September 2021) | Viewed by 31091

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Special Issue Editors

Prof. Dr. Laurent Bonello

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Guest Editor

Intensive Care Unit, Hopital Universitaire Nord, Chemin des Bourrely, 13015 Marseille, France
Interests: acute coroanry syndrome; cardiogenic shock; left ventricle assist devices; antithrombotic tehrapy
Special Issues, Collections and Topics in MDPI journals

Dr. Clement Delmas

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Guest Editor

Intensive Cardiac Care Unit, Rangueil University Hospital, 1 Avenue Jean Poulhes, 31059 Toulouse, France
Interests: heart failure; cardiogenic shock; mechanical circulatory support; LVAD

Special Issue Information

Dear Colleagues,

Cardiogenic shock remains one of the main challenge in contemporary cardiology. Its incidence is steady and its related mortality remains high. However there are some changes. First the diagnosis and classification for CS, which remained vague, are improving. Second, the recent years have seen a change in the landscape of CS etiologies with a reduction in CS related to acute coronary syndromes and a steady increase in CS related to the acute decompensation of chronic heart failure. In addition there are some interesting advances regarding the care and monitoring of these patients which could help to improve the outcome. In particular left ventricle assist devices and extracorporeal membrane oxygenation have emerged has potential game changers in the care of these patients. Randomized clinical trials in this clinical setting are scarce and difficult to perform. However they remain critical in order to determine the optimal therapeutic strategy and the correct place for assist device. Pathways have emerged to perform RCT in this setting with careful selection of patients, ethical and methodological improvements and definition of valid endpoints. In the present special issue, we would like to provide some space for up-to date review of current state of the art diagnosis and care of CS, but also invite investigators to present original and novel findings regarding CS.

Prof. Dr. Laurent Bonello
Dr. Clement Delmas
Guest Editors

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Keywords

Acute heart failure
Acute cardiac care
Cardiogenic shock
Physiopathology
Epidemiology
Mortality
Mechanical circulatory support
Organ replacement therapies

Published Papers (13 papers)

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12 pages, 5306 KiB

Open AccessArticle

Elevated Plasma Bioactive Adrenomedullin and Mortality in Cardiogenic Shock: Results from the OptimaCC Trial

by Koji Takagi, Bruno Levy, Antoine Kimmoun, Òscar Miró, Kévin Duarte, Ayu Asakage, Alice Blet, Benjamin Deniau, Janin Schulte, Oliver Hartmann, Gad Cotter, Beth A Davison, Etienne Gayat and Alexandre Mebazaa

J. Clin. Med. 2021, 10(19), 4512; https://doi.org/10.3390/jcm10194512 - 29 Sep 2021

Cited by 3 | Viewed by 1855

Abstract

Aims: Bioactive adrenomedullin (bio-ADM) was recently shown to be a prognostic marker in patients with acute circulatory failure. We investigate the association of bio-ADM with organ injury, functional impairment, and survival in cardiogenic shock (CS). Methods: OptimaCC was a multicenter and randomized trial in 57 patients with CS. In this post-hoc analysis, the primary endpoint was to assess the association between bio-ADM and 30-day all-cause mortality. Secondary endpoints included adverse events and parameters of organ injury or functional impairment. Results: Bio-ADM values were higher in 30-day non-survivors than 30-day survivors at inclusion (median (interquartile range) 67.0 (54.6–142.9) pg/mL vs. 38.7 (23.8–63.6) pg/mL, p = 0.010), at 24 h (p = 0.012), and up to 48 h (p = 0.027). Using a bio-ADM cutoff of 53.8 pg/mL, patients with increased bio-ADM had a HR of 3.90 (95% confidence interval 1.43–10.68, p = 0.008) for 30-day all-cause mortality, and similar results were observed even after adjustment for severity scores. Patients with the occurrence of refractory CS had higher bio-ADM value at inclusion (90.7 (59.9–147.7) pg/mL vs. 40.7 (23.0–64.7) pg/mL p = 0.005). Bio-ADM values at inclusion were correlated with pulmonary vascular resistance index, estimated glomerular filtration rate, and N-terminal pro-B-type natriuretic peptide (r = 0.49, r = –0.47, and r = 0.64, respectively; p < 0.001). Conclusions: In CS patients, the values of bio-ADM are associated with some parameters of organ injury and functional impairment and are prognostic for the occurrence of refractory CS and 30-day mortality. Full article

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

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11 pages, 827 KiB

Open AccessArticle

Successful Reversal of Severe Tachycardia-Induced Cardiomyopathy with Cardiogenic Shock by Urgent Rhythm or Rate Control: Only Rhythm and Rate Matter

by Kim Volle, Clément Delmas, Anne Rollin, Quentin Voglimacci-Stephanopoli, Pierre Mondoly, Eve Cariou, Franck Mandel, Hubert Delasnerie, Maxime Beneyto, Michel Galinier, Yoan Lavie-Badie, Didier Carrié, Jerôme Roncalli, Olivier Lairez, Pauline Fournier, Caroline Biendel and Philippe Maury

J. Clin. Med. 2021, 10(19), 4504; https://doi.org/10.3390/jcm10194504 - 29 Sep 2021

Cited by 7 | Viewed by 1805

Abstract

Background and objectives Severe forms of Tachycardia-induced cardiomyopathy (TIC) with cardiogenic shock are not well described so far, and efficiency of catheter ablation in this setting is unknown. Methods We retrospectively included consecutive patients admitted to the Intensive Cardiac Care Unit for acute heart failure with cardiogenic shock associated with atrial arrhythmia and managed by ablation. Result Fourteen patients were included, each with cardiogenic shock and two needing the use of extracorporeal membrane oxygenation. Successful ablation was performed in the acute setting or over the following weeks. Two patients experienced relapses of arrhythmias and were treated by new ablation procedures. At 7.5 ± 5 months follow-up, all patient were alive with stable sinus rhythm. The left ventricular Ejection Fraction dramatically improved (21 vs. 54%, p = 0.001) as well as the end-diastolic left ventricular diameter (61 vs. 51 mm, p = 0.01) and NYHA class (class IV in all vs. median 1, p = 0.002). Conclusion Restoration and maintenance of sinus rhythm in severe TIC with cardiogenic shock and atrial arrhythmias lead to a major increase or normalization of LVEF, reduction of ventricular dimensions, and improvement in functional status. Ablation is efficient in long-term maintenance of sinus rhythm and may be proposed early in refractory cases. Full article

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

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12 pages, 1040 KiB

Open AccessArticle

Severe Myocardial Dysfunction after Non-Ischemic Cardiac Arrest: Effectiveness of Percutaneous Assist Devices

by Stéphane Manzo-Silberman, Christoph Nix, Andreas Goetzenich, Pierre Demondion, Chantal Kang, Michel Bonneau, Alain Cohen-Solal, Pascal Leprince and Guillaume Lebreton

J. Clin. Med. 2021, 10(16), 3623; https://doi.org/10.3390/jcm10163623 - 17 Aug 2021

Cited by 1 | Viewed by 1506

Abstract

Introduction: Despite the improvements in standardized cardiopulmonary resuscitation, survival remains low, mainly due to initial myocardial dysfunction and hemodynamic instability. Our goal was to compare the efficacy of two left ventricular assist devices on resuscitation and hemodynamic supply in a porcine model of ventricular fibrillation (VF) cardiac arrest. Methods: Seventeen anaesthetized pigs had 12 min of untreated VF followed by 6 min of chest compression and boluses of epinephrine. Next, a first defibrillation was attempted and pigs were randomized to any of the three groups: control (n = 5), implantation of an percutaneous left ventricular assist device (Impella, n = 5) or extracorporeal membrane oxygenation (ECMO, n = 7). Hemodynamic and myocardial functions were evaluated invasively at baseline, at return of spontaneous circulation (ROSC), after 10–30–60–120–240 min post-resuscitation. The primary endpoint was the rate of ROSC. Results: Only one of 5 pigs in the control group, 5 of 5 pigs in the Impella group, and 5 of 7 pigs in the ECMO group had ROSC (p < 0.05). Left ventricular ejection fraction at 240 min post-resuscitation was 37.5 ± 6.2% in the ECMO group vs. 23 ± 3% in the Impella group (p = 0.06). No significant difference in hemodynamic parameters was observed between the two ventricular assist devices. Conclusion: Early mechanical circulatory support appeared to improve resuscitation rates in a shockable rhythm model of cardiac arrest. This approach appears promising and should be further evaluated. Full article

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

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10 pages, 642 KiB

Open AccessArticle

Outcome and Predictors for Mortality in Patients with Cardiogenic Shock: A Dutch Nationwide Registry-Based Study of 75,407 Patients with Acute Coronary Syndrome Treated by PCI

by Mina Karami, Elma J. Peters, Wim K. Lagrand, Saskia Houterman, Corstiaan A. den Uil, Annemarie E. Engström, Luuk C. Otterspoor, Jan Paul Ottevanger, Irlando A. Ferreira, Jose M. Montero-Cabezas, Krischan Sjauw, Jan van Ramshorst, Adriaan O. Kraaijeveld, Niels J. W. Verouden, Erik Lipsic, Alexander P. Vlaar, Jose P. S. Henriques and on Behalf of the PCI Registration Committee of The Netherlands Heart Registration

J. Clin. Med. 2021, 10(10), 2047; https://doi.org/10.3390/jcm10102047 - 11 May 2021

Cited by 5 | Viewed by 1914

Abstract

It is important to gain more insight into the cardiogenic shock (CS) population, as currently, little is known on how to improve outcomes. Therefore, we assessed clinical outcome in acute coronary syndrome (ACS) patients treated by percutaneous coronary intervention (PCI) with and without CS at admission. Furthermore, the incidence of CS and predictors for mortality in CS patients were evaluated. The Netherlands Heart Registration (NHR) is a nationwide registry on all cardiac interventions. We used NHR data of ACS patients treated with PCI between 2015 and 2019. Among 75,407 ACS patients treated with PCI, 3028 patients (4.1%) were identified with CS, respectively 4.3%, 3.9%, 3.5%, and 4.3% per year. Factors associated with mortality in CS were age (HR 1.02, 95%CI 1.02–1.03), eGFR (HR 0.98, 95%CI 0.98–0.99), diabetes mellitus (DM) (HR 1.25, 95%CI 1.08–1.45), multivessel disease (HR 1.22, 95%CI 1.06–1.39), prior myocardial infarction (MI) (HR 1.24, 95%CI 1.06–1.45), and out-of-hospital cardiac arrest (OHCA) (HR 1.71, 95%CI 1.50–1.94). In conclusion, in this Dutch nationwide registry-based study of ACS patients treated by PCI, the incidence of CS was 4.1% over the 4-year study period. Predictors for mortality in CS were higher age, renal insufficiency, presence of DM, multivessel disease, prior MI, and OHCA. Full article

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

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13 pages, 1229 KiB

Open AccessArticle

Risk Scores in ST-Segment Elevation Myocardial Infarction Patients with Refractory Cardiogenic Shock and Veno-Arterial Extracorporeal Membrane Oxygenation

by Carl Semaan, Arthur Charbonnier, Jeremy Pasco, Walid Darwiche, Christophe Saint Etienne, Xavier Bailleul, Thierry Bourguignon, Laurent Fauchier, Denis Angoulvant, Fabrice Ivanes and Thibaud Genet

J. Clin. Med. 2021, 10(5), 956; https://doi.org/10.3390/jcm10050956 - 01 Mar 2021

Cited by 5 | Viewed by 1829

Abstract

Although many risk models have been tested in patients implanted by veno-arterial extracorporeal membrane oxygenation (VA-ECMO), few scores assessed patients’ prognosis in the setting of ST-segment elevation myocardial infarction (STEMI) with refractory cardiogenic shock. We aimed at assessing the performance of risk scores, notably the prEdictioN of Cardiogenic shock OUtcome foR AMI patients salvaGed by VA-ECMO (ENCOURAGE) score, for predicting mortality in this particular population. This retrospective observational study included patients admitted to Tours University Hospital for STEMI with cardiogenic shock and requiring hemodynamic support by VA-ECMO. Among the fifty-one patients, the 30-day and 6-month survival rates were 63% and 56% respectively. Thirty days after VA-ECMO therapy, probabilities of mortality were 12, 17, 33, 66, 80% according to the ENCOURAGE score classes 0–12, 13–18, 19–22, 23–27, and ≥28, respectively. The ENCOURAGE score (AUC of the Receiving Operating Characteristic curve = 0.83) was significantly better compared to other risk scores. The hazard ratio for survival at 30 days for each point of the ENCOURAGE score was 1.10 (CI 95% (1.06, 1.15); p < 0.001). Decision curve analysis indicated that the ENCOURAGE score had the best clinical usefulness of the tested risk scores and the Hosmer–Lemeshow test suggested an accurate calibration. Our data suggest that the ENCOURAGE score is valid and the most relevant score to predict 30-day mortality after VA-ECMO therapy in STEMI patients with refractory cardiogenic shock. It may help decision-making teams to better select STEMI patients with shock for VA-ECMO therapy. Full article

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

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12 pages, 1200 KiB

Open AccessArticle

IMPELLA^® or Extracorporeal Membrane Oxygenation for Left Ventricular Dominant Refractory Cardiogenic Shock

by Guillaume Schurtz, Natacha Rousse, Ouriel Saura, Vincent Balmette, Flavien Vincent, Nicolas Lamblin, Sina Porouchani, Basile Verdier, Etienne Puymirat, Emmanuel Robin, Eric Van Belle, André Vincentelli, Nadia Aissaoui, Cédric Delhaye, Clément Delmas, Alessandro Cosenza, Laurent Bonello, Francis Juthier, Mouhamed Djahoum Moussa and Gilles Lemesle

J. Clin. Med. 2021, 10(4), 759; https://doi.org/10.3390/jcm10040759 - 14 Feb 2021

Cited by 12 | Viewed by 2607

Abstract

Mechanical circulatory support (MCS) devices are effective tools in managing refractory cardiogenic shock (CS). Data comparing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and IMPELLA^® are however scarce. We aimed to assess outcomes of patients implanted with these two devices and eligible to both systems. From 2004 to 2020, we retrospectively analyzed 128 patients who underwent VA-ECMO or IMPELLA^® in our institution for refractory left ventricle (LV) dominant CS. All patients were eligible to both systems: 97 patients were first implanted with VA-ECMO and 31 with IMPELLA^®. The primary endpoint was 30-day all-cause death. VA-ECMO patients were younger (52 vs. 59.4, p = 0.006) and had a higher lactate level at baseline than those in the IMPELLA^® group (6.84 vs. 3.03 mmol/L, p < 0.001). Duration of MCS was similar between groups (9.4 days vs. 6 days in the VA-ECMO and IMPELLA^® groups respectively, p = 0.077). In unadjusted analysis, no significant difference was observed between groups in 30-day mortality: 43.3% vs. 58.1% in the VA-ECMO and IMPELLA^® groups, respectively (p = 0.152). After adjustment, VA-ECMO was associated with a significant reduction in 30-day mortality (HR = 0.25, p = 0.004). A higher rate of MCS escalation was observed in the IMPELLA^® group: 32.3% vs. 10.3% (p = 0.003). In patients eligible to either VA-ECMO or IMPELLA^® for LV dominant refractory CS, VA-ECMO was associated with improved survival rate and a lower need for escalation. Full article

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

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15 pages, 1436 KiB

Open AccessArticle

Biventricular Unloading with Impella and Venoarterial Extracorporeal Membrane Oxygenation in Severe Refractory Cardiogenic Shock: Implications from the Combined Use of the Devices and Prognostic Risk Factors of Survival

by Georgios Chatzis, Styliani Syntila, Birgit Markus, Holger Ahrens, Nikolaos Patsalis, Ulrich Luesebrink, Dimitar Divchev, Mariana Parahuleva, Hanna Al Eryani, Bernhard Schieffer and Konstantinos Karatolios

J. Clin. Med. 2021, 10(4), 747; https://doi.org/10.3390/jcm10040747 - 13 Feb 2021

Viewed by 1972

Abstract

Since mechanical circulatory support (MCS) devices have become integral component in the therapy of refractory cardiogenic shock (RCS), we identified 67 patients in biventricular support with Impella and venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO) for RCS between February 2013 and December 2019 and evaluated the risk factors of mortality in this setting. Mean age was 61.07 ± 10.7 and 54 (80.6%) patients were male. Main cause of RCS was acute myocardial infarction (AMI) (74.6%), while 44 (65.7%) were resuscitated prior to admission. The mean Simplified Acute Physiology Score II (SAPS II) and Sequential Organ Failure Assessment Score (SOFA) score on admission was 73.54 ± 16.03 and 12.25 ± 2.71, respectively, corresponding to an expected mortality of higher than 80%. Vasopressor doses and lactate levels were significantly decreased within 72 h on biventricular support (p < 0.05 for both). Overall, 17 (25.4%) patients were discharged to cardiac rehabilitation and 5 patients (7.5%) were bridged successfully to ventricular assist device implantation, leading to a total of 32.8% survival on hospital discharge. The 6-month survival was 31.3%. Lactate > 6 mmol/L, vasoactive score > 100 and pH < 7.26 on initiation of biventricular support, as well as Charlson comorbity index > 3 and prior resuscitation were independent predictors of survival. In conclusion, biventricular support with Impella and VA-ECMO in patients with RCS is feasible and efficient leading to a better survival than predicted through traditional risk scores, mainly via significant hemodynamic improvement and reduction in lactate levels. Full article

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

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13 pages, 431 KiB

Open AccessArticle

Early Evaluation of Patients on Axial Flow Pump Support for Refractory Cardiogenic Shock Is Associated with Left Ventricular Recovery

by Jérôme Fagot, Frédéric Bouisset, Laurent Bonello, Caroline Biendel, Thibaut Lhermusier, Jean Porterie, Jerome Roncalli, Michel Galinier, Meyer Elbaz, Olivier Lairez and Clément Delmas

J. Clin. Med. 2020, 9(12), 4130; https://doi.org/10.3390/jcm9124130 - 21 Dec 2020

Cited by 3 | Viewed by 1910

Abstract

We investigated prognostic factors associated with refractory left ventricle (LV) failure leading to LV assist device (LVAD), heart transplant or death in patients on an axial flow pump support for cardiogenic shock (CS). Sixty-two CS patients with an Impella^® CP or 5.0 implant were retrospectively enrolled, and clinical, biological, echocardiographic, coronarographic and management data were collected. They were compared according to the 30-day outcome. Patients were mainly male (n = 55, 89%), 58 ± 11 years old and most had no history of heart failure or coronary artery disease (70%). The main etiology of CS was acute coronary syndrome (n = 57, 92%). They presented with severe LV failure (LV ejection fraction (LVEF) 22 ± 9%), organ malperfusion (lactate 3.1 ± 2.1 mmol/L), and frequent use of inotropes, vasopressors, and mechanical ventilation (59, 66 and 30%, respectively). At 24 h, non-recovery was associated with higher total bilirubin (odds ratios (OR) 1.07 (1.00–1.14); p = 0.039), lower LVEF (OR 0.89 (0.81–0.96); p = 0.006) and the number of administrated amines (OR 4.31 (1.30–14.30); p = 0.016). Early evaluation in patients with CS with an axial flow pump implant may enable the identification of factors associated with an unlikely recovery and would call for early screening for LVAD or heart transplant. Full article

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

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14 pages, 1083 KiB

Open AccessArticle

Long-Term Clinical Outcome of Cardiogenic Shock Patients Undergoing Impella CP Treatment vs. Standard of Care

by Clemens Scherer, Enzo Lüsebrink, Danny Kupka, Thomas J. Stocker, Konstantin Stark, Christopher Stremmel, Mathias Orban, Tobias Petzold, Antonia Germayer, Katharina Mauthe, Stefan Kääb, Julinda Mehilli, Daniel Braun, Hans Theiss, Stefan Brunner, Jörg Hausleiter, Steffen Massberg and Martin Orban

J. Clin. Med. 2020, 9(12), 3803; https://doi.org/10.3390/jcm9123803 - 24 Nov 2020

Cited by 14 | Viewed by 2729

Abstract

The number of patients treated with the mechanical circulatory support device Impella Cardiac Power (CP) for cardiogenic shock is steadily increasing. The aim of this study was to investigate long-term survival and complications related to this modality. Patients undergoing Impella CP treatment for cardiogenic shock were retrospectively enrolled and matched with cardiogenic shock patients not treated with mechanical circulatory support between 2010 and 2020. Data were collected from the cardiogenic shock registry of the university hospital of Munich (DRKS00015860). 70 patients with refractory cardiogenic shock without mechanical circulatory support were matched with 70 patients treated with Impella CP. At presentation, the mean age was 67 ± 15 years with 80% being male in the group without support and 67 ± 14 years (p = 0.97) with 76% being male (p = 0.68) in the group with Impella. There was no significant difference in the rate of cardiac arrest (47% vs. 51%, p = 0.73) and myocardial infarction was the predominant cause of cardiogenic shock in both groups (70% vs. 77%). A total of 41% of patients without cardiocirculatory support and 54% of patients with Impella support died during the first month (p = 0.17). After one year, mortality rates were similar in both groups (55% in conventional vs. 59% in Impella CP group, p = 0.30) as was mortality rate at long-term 5-years follow-up (64% in conventional vs. 73% in Impella CP group, p = 0.33). The rate of clinically significant bleedings during ICU stay was lower in the conventional group than in the Impella support group (15% vs. 43%, p = 0.002). In this small observational and non-randomized analysis no difference in long-term outcome between patients treated with Impella CP vs. guideline directed cardiogenic shock therapy without mechanical circulatory support could be detected. Care must be taken regarding the high rate of bleeding and vascular complications when using Impella CP. Large, adequately powered studies are urgently needed to investigate the efficacy and safety of Impella CP in cardiogenic shock. Full article

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

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11 pages, 2216 KiB

Open AccessArticle

Levosimendan Plus Dobutamine in Acute Decompensated Heart Failure Refractory to Dobutamine

by William Juguet, Damien Fard, Laureline Faivre, Athanasios Koutsoukis, Camille Deguillard, Nicolas Mongardon, Armand Mekontso-Dessap, Raphaelle Huguet and Pascal Lim

J. Clin. Med. 2020, 9(11), 3605; https://doi.org/10.3390/jcm9113605 - 09 Nov 2020

Cited by 6 | Viewed by 3543

Abstract

Randomized studies showed that Dobutamine and Levosimendan have similar impact on outcome but their combination has never been assessed in acute decompensated heart failure (ADHF) with low cardiac output. This is a retrospective, single-center study that included 89 patients (61 ± 15 years) admitted for ADHF requiring inotropic support. The first group consisted of patients treated with dobutamine alone (n = 42). In the second group, levosimendan was administered on top of dobutamine, when the superior vena cava oxygen saturation (ScVO2) remained <60% after 3 days of dobutamine treatment (n = 47). The primary outcome was the occurrence of major cardiovascular events (MACE) at 6 months, defined as all cause death, heart transplantation or need for mechanical circulatory support. Baseline clinical characteristics were similar in both groups. At day-3, the ScVO2 target (>60%) was reached in 36% and 32% of patients in the dobutamine and dobutamine-levosimendan group, respectively. After adding levosimendan, 72% of the dobutamine-levosimendan-group reached the ScVO2 target value at dobutamine weaning. At six months, 42 (47%) patients experienced MACE (n = 29 for death). MACE was less frequent in the dobutamine-levosimendan (32%) than in the dobutamine-group (64%, p = 0.003). Independent variables associated with outcome were admission systolic blood pressure and dobutamine-levosimendan strategy (OR = 0.44 (0.23–0.84), p = 0.01). In conclusion, levosimendan added to dobutamine may improve the outcome of ADHF refractory to dobutamine alone. Full article

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

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12 pages, 1658 KiB

Open AccessArticle

Clinical Significance of Low-Flow Time in Patients Undergoing Extracorporeal Cardiopulmonary Resuscitation: Results from the RESCUE Registry

by Ik Hyun Park, Jeong Hoon Yang, Woo Jin Jang, Woo Jung Chun, Ju Hyeon Oh, Yong Hwan Park, Cheol Woong Yu, Hyun-Joong Kim, Bum Sung Kim, Jin-Ok Jeong, Hyun Jong Lee and Hyeon-Cheol Gwon

J. Clin. Med. 2020, 9(11), 3588; https://doi.org/10.3390/jcm9113588 - 07 Nov 2020

Cited by 7 | Viewed by 1817

Abstract

Limited data are available on the association between low-flow time and survival in patients with in-hospital cardiac arrest (IHCA) who undergo extracorporeal cardiopulmonary resuscitation (ECPR). We evaluated data from 183 IHCA patients who underwent ECPR as a rescue procedure. Patients were divided into two groups: patients undergoing extracorporeal membrane oxygenation as an adjunct to standard cardiopulmonary resuscitation for less than 38 min (n = 110) or for longer than 38 min (n = 73). The ECPR ≤ 38 min group had a significantly greater incidence of survival to discharge compared to the ECPR > 38 min group (40.0% versus 24.7%, p = 0.032). The incidence of good neurologic outcomes at discharge tended to be greater in the ECPR ≤ 38 min group than in the ECPR > 38 min group (35.5% versus 24.7%, p = 0.102). The incidences of limb ischemia (p = 0.354) and stroke (p = 0.805) were similar between the two groups, but major bleeding occurred less frequently in the ECPR ≤ 38 min group compared to the ECPR > 38 min group (p = 0.002). Low-flow time ≤ 38 min may reduce the risk of mortality and fatal neurologic damage and could be a measure of optimal management in patients with IHCA. Full article

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

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8 pages, 1080 KiB

Open AccessArticle

Hemodynamic Profiles of Cardiogenic Shock Depending on Their Etiology

by Mélanie Gaubert, Marc Laine, Noémie Resseguier, Nadia Aissaoui, Etienne Puymirat, Gilles Lemesle, Pierre Michelet, Sami Hraiech, Bruno Lévy, Clément Delmas and Laurent Bonello

J. Clin. Med. 2020, 9(11), 3384; https://doi.org/10.3390/jcm9113384 - 22 Oct 2020

Cited by 7 | Viewed by 2778

Abstract

The pathophysiology of cardiogenic shock (CS) varies depending on its etiology, which may lead to different hemodynamic profiles (HP) and may help tailor therapy. We aimed to assess the HP of CS patients according to their etiologies of acute myocardial infarction (AMI) and acute decompensated chronic heart failure (ADCHF). We included patients admitted for CS secondary to ADCHF and AMI. HP were measured before the administration of any inotrope or vasopressor. Systemic Vascular Resistances index (SVRi), Cardiac Index (CI), and Cardiac Power Index (CPI) were measured by trans-thoracic Doppler echocardiography on admission. Among 37 CS patients, 28 had CS secondary to ADCHF or AMI and were prospectively included. The two groups were similar in terms of demographic data and shock severity criteria. AMI CS was associated with lower SVRi compared to CS related to ADCHF: 2010 (interquartile range (IQR): 1895–2277) vs. 2622 (2264–2993) dynes-s·cm⁻⁵·m⁻² (p = 0.002). A trend toward a higher CI was observed: respectively 2.13 (1.88–2.18) vs. 1.78 (1.65–1.96) L·min⁻¹·m⁻² (p = 0.067) in AMICS compared to ADCHF. CS patients had different HP according to their etiologies. AMICS had lower SVR and tended to have a higher CI compared to ADHF CS. These differences should be taken into account for patient selection in future research. Full article

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

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Review

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9 pages, 3353 KiB

Open AccessReview

Ultrasound Assessment in Cardiogenic Shock Weaning: A Review of the State of the Art

by Rebeca Muñoz-Rodríguez, Martín Jesús García-González, Pablo Jorge-Pérez, Marta M. Martín-Cabeza, Maria Manuela Izquierdo-Gómez, Belén Marí-López, María Amelia Duque-González, Antonio Barragán-Acea and Juan Lacalzada-Almeida

J. Clin. Med. 2021, 10(21), 5108; https://doi.org/10.3390/jcm10215108 - 30 Oct 2021

Cited by 6 | Viewed by 3650

Abstract

Cardiogenic shock (CS) is associated with a high in-hospital mortality despite the achieved advances in diagnosis and management. Invasive mechanical ventilation and circulatory support constitute the highest step in cardiogenic shock therapy. Once established, taking the decision of weaning from such support is challenging. Intensive care unit (ICU) bedside echocardiography provides noninvasive, immediate, and low-cost monitoring of hemodynamic parameters such as cardiac output, filling pressure, structural disease, congestion status, and device functioning. Supplemented by an ultrasound of the lung and diaphragm, it is able to provide valuable information about signs suggesting a weaning failure. The aim of this article was to review the state of the art taking into account current evidence and knowledge on ICU bedside ultrasound for the evaluation of weaning from mechanical ventilation and circulatory support in cardiogenic shock. Full article

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

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