Cardiogenic Shock

2017 ◽  
Author(s):  
Martin Chen ◽  
Muoi Trinh
Keyword(s):  
Heart Failure ◽  
Cardiogenic Shock ◽  
Acute Decompensated Heart Failure ◽  
Preoperative Evaluation ◽  
Perioperative Period ◽  
Decompensated Heart Failure ◽  
Postoperative Management ◽  
Perioperative Morbidity ◽  
Circulatory Assist Devices ◽  
Patients At Risk

Heart failure and cardiogenic shock are important causes of perioperative morbidity and mortality that require prompt recognition prior to the institution of specialized monitoring and treatment, including the consideration of circulatory assist devices. Patients at risk for perioperative heart failure require special consideration with respect to preoperative evaluation, medical optimization prior to proceeding with surgery, and monitoring throughout the perioperative period. The intraoperative and postoperative management need to be carefully planned in order to avoid the development of acute decompensated heart failure and cardiogenic shock. This chapter reviews the perioperative assessment and management of heart failure patients as well as the management of perioperative cardiogenic shock.

scholarly journals Invasive Hemodynamic Assessment and Classification of In-Hospital Mortality Risk Among Patients With Cardiogenic Shock

2020 ◽  
Vol 13 (9) ◽  
Author(s):  
Katherine L. Thayer ◽  
Elric Zweck ◽  
Mohyee Ayouty ◽  
A. Reshad Garan ◽  
Jaime Hernandez-Montfort ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Unmet Need ◽  
Staging System ◽  
Decompensated Heart Failure ◽  
Right Atrial ◽  
Hemodynamic Assessment ◽  
Patients At Risk ◽  
The Impact

Background: Risk stratifying patients with cardiogenic shock (CS) is a major unmet need. The recently proposed Society for Cardiovascular Angiography and Interventions (SCAI) stages as an approach to identify patients at risk for in-hospital mortality remains under investigation. We studied the utility of the SCAI stages and further explored the impact of hemodynamic congestion on clinical outcomes. Methods: The CS Working Group registry includes patients with CS from 8 medical centers enrolled between 2016 and 2019. Patients were classified by the maximum SCAI stage (B–E) reached during their hospital stay according to drug and device utilization. In-hospital mortality was evaluated for association with SCAI stages and hemodynamic congestion. Results: Of the 1414 patients with CS, the majority were due to decompensated heart failure (50%) or myocardial infarction (MI; 35%). In-hospital mortality was 31% for the total cohort, but higher among patients with MI (41% versus 26%, MI versus heart failure, P <0.0001). Risk for in-hospital mortality was associated with increasing SCAI stage (odds ratio [95% CI], 3.25 [2.63–4.02]) in both MI and heart failure cohorts. Hemodynamic data was available in 1116 (79%) patients. Elevated biventricular filling pressures were common among patients with CS, and right atrial pressure was associated with increased mortality and higher SCAI Stage. Conclusions: Our findings support an association between the proposed SCAI staging system and in-hospital mortality among patient with heart failure and MI. We further identify that venous congestion is common and identifies patients with CS at high risk for in-hospital mortality. These findings provide may inform future management protocols and clinical studies.

scholarly journals Implementation of a Cardiogenic Shock Team and Clinical Outcomes (INOVA-SHOCK Registry): Observational and Retrospective Study (Preprint)

2018 ◽  
Author(s):  
Behnam Tehrani ◽  
Alexander Truesdell ◽  
Ramesh Singh ◽  
Charles Murphy ◽  
Patricia Saulino
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Clinical Outcomes ◽  
Mechanical Circulatory Support ◽  
Acute Decompensated Heart Failure ◽  
Survival Rates ◽  
Decompensated Heart Failure ◽  
Circulatory Support

BACKGROUND The development and implementation of a Cardiogenic Shock initiative focused on increased disease awareness, early multidisciplinary team activation, rapid initiation of mechanical circulatory support, and hemodynamic-guided management and improvement of outcomes in cardiogenic shock. OBJECTIVE The objectives of this study are (1) to collect retrospective clinical outcomes for acute decompensated heart failure cardiogenic shock and acute myocardial infarction cardiogenic shock, and compare current versus historical survival rates and clinical outcomes; (2) to evaluate Inova Heart and Vascular Institute site specific outcomes before and after initiation of the Cardiogenic Shock team on January 1, 2017; (3) to compare outcomes related to early implementation of mechanical circulatory support and hemodynamic-guided management versus historical controls; (4) to assess survival to discharge rate in patients receiving intervention from the designated shock team and (5) create a clinical archive of Cardiogenic Shock patient characteristics for future analysis and the support of translational research studies. METHODS This is an observational, retrospective, single center study. Retrospective and prospective data will be collected in patients treated at the Inova Heart and Vascular Institute with documented cardiogenic shock as a result of acute decompensated heart failure or acute myocardial infarction. This registry will include data from patients prior to and after the initiation of the multidisciplinary Cardiogenic Shock team on January 1, 2017. Clinical outcomes associated with early multidisciplinary team intervention will be analyzed. In the study group, all patients evaluated for documented cardiogenic shock (acute decompensated heart failure cardiogenic shock, acute myocardial infarction cardiogenic shock) treated at the Inova Heart and Vascular Institute by the Cardiogenic Shock team will be included. An additional historical Inova Heart and Vascular Institute control group will be analyzed as a comparator. Means with standard deviations will be reported for outcomes. For categorical variables, frequencies and percentages will be presented. For continuous variables, the number of subjects, mean, standard deviation, minimum, 25th percentile, median, 75th percentile and maximum will be reported. Reported differences will include standard errors and 95% CI. RESULTS Preliminary data analysis for the year 2017 has been completed. Compared to a baseline 2016 survival rate of 47.0%, from 2017 to 2018, CS survival rates were increased to 57.9% (58/110) and 81.3% (81/140), respectively (P=.01 for both). Study data will continue to be collected until December 31, 2018. CONCLUSIONS The preliminary results of this study demonstrate that the INOVA SHOCK team approach to the treatment of Cardiogenic Shock with early team activation, rapid initiation of mechanical circulatory support, hemodynamic-guided management, and strict protocol adherence is associated with superior clinical outcomes: survival to discharge and overall survival when compared to 2015 and 2016 outcomes prior to Shock team initiation. What may limit the generalization of these results of this study to other populations are site specific; expertise of the team, strict algorithm adherence based on the INOVA SHOCK protocol, and staff commitment to timely team activation. Retrospective clinical outcomes (acute decompensated heart failure cardiogenic shock, acute myocardial infarction cardiogenic shock) demonstrated an increase in current survival rates when compared to pre-Cardiogenic Shock team initiation, rapid team activation and diagnosis and timely utilization of mechanical circulatory support. CLINICALTRIAL ClinicalTrials.gov NCT03378739; https://clinicaltrials.gov/ct2/show/NCT03378739 (Archived by WebCite at http://www.webcitation.org/701vstDGd)

scholarly journals Predicting Survival in Patients With Acute Decompensated Heart Failure Complicated by Cardiogenic Shock

2020 ◽  
Author(s):  
Nuccia Morici ◽  
Giovanna Viola ◽  
Laura Antolini ◽  
Michela Dal Martello ◽  
Alice Sacco ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiogenic Shock ◽  
Acute Decompensated Heart Failure ◽  
External Validation ◽  
Area Under The Curve ◽  
Decompensated Heart Failure ◽  
Treatment Intensification ◽  
Specific Patient ◽  
Short Term Mortality ◽  
Overall Mortality

Abstract Background: Acute decompensated heart failure (ADHF) complicated by cardiogenic shock (CS) has unique pathophysiological background requiring specific patient stratification, management and therapeutic targets. Accordingly, the aim of this study was to derive a simple stratification tool to predict survival in patients with ADHF complicated by CS. Methods and results: We analyzed data from a historic cohort of 87 ADHF-CS consecutive patients, eligible to heart replacement therapy (HRT), enrolled between 2015 and 2019. The association between selected independent variables (age, lactates and creatinine, ALC-shock score) and 28-day overall mortality was investigated through a multivariable logistic model. Predictive validity was assessed throughout an internal and external validation and compared to the Cardshock score. A nomogram was developed for predicting 28-day mortality. Overall 28-day mortality was 34%. Among patients who survived, 38 (67%) were treated with HRT: heart transplantation was performed in 68%, the remaining received an LVAD. The ALC-shock score showed better discrimination (Area Under the Curve-AUC- 0.82; 95% CI 0.73-0.91) as compared to the Cardshock score (AUC 0.67; 95% CI 0.55-0.79) (p = 0.009) to predict 28-days overall mortality. In the validation cohort the AUC for the ALC-shock score was 0.66. Conclusions: A model including age, lactates and creatinine on admission (ALC-Shock score) could be considered to predict short-term mortality in CS-ADHF patients in order to drive towards a treatment intensification. Disclosures: Dr. Garan is supported by National Institutes of Health Grant No. KL2TR001874 and has received honoraria from Abiomed. Dr. Colombo reports institutional grant support from Abbott Vascular. None of the listed entities has had any involvement with the development of the manuscript. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.Research ethics: This study was approved by the Local Ethics Committee of Milano Area 3 of the ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milano (reference number: 543-23092020).

Abstract 19477: Transthoracic Bioimpedance Monitoring Predicts Readmission After Hospitalization for Heart Failure: Preliminary Results From the SENTINEL-HF Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Chad E Darling ◽  
Silviu Dovancescu ◽  
Jarno Riistama ◽  
Jane Saczynski ◽  
Nisha Kini ◽  
...  
Keyword(s):  
Heart Failure ◽  
At Risk ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Detection Algorithm ◽  
Fluid Accumulation ◽  
Predictive Values ◽  
Preliminary Results ◽  
Patients At Risk

Introduction: Patients and health systems are focused on reducing readmissions for patients with acute decompensated heart failure (ADHF). Readmission after hospitalization is often secondary to HF decompensation, but it remains challenging to identify patients at-risk. Bioimpedance is a validated marker of thoracic fluid accumulation. We examined whether changes in bioimpedance, measured using a Fluid Accumulation Vest (FAV), predicted subsequent HF decompensation in patients discharged after ADHF. Methods: Participants included 83 patients hospitalized for ADHF. Subjects were trained on the use of a FAV-smartphone dyad to obtain and transmit a 5-minute bioimpedance measurement once daily for 45-days after discharge.(see Figure) The outcome of interest, HF-related readmission was assessed using participant report and medical records. Sensitivity, specificity, negative and positive predictive values were calculated to describe the efficacy of the bioimpedance alert algorithm as a predictor of HF readmission. Results: Subject characteristics: mean age 68 ± 11 years, 36% female, 92% white, mean ejection fraction of 44 ± 19%. 49 participants completed the 45-day follow-up and had sufficient, daily FAV data for analysis. Our main outcome of HF-related rehospitalization occurred in 8% of patients during follow-up. The decompensation detection algorithm demonstrated a sensitivity of 75%, specificity of 47%, positive/negative predictive values of 11% and 96%, respectively. Conclusions: The preliminary results of this ongoing study suggest that HF readmissions may be predicted with modest sensitivity by our current decompensation detection algorithm. Further refinement of our transthoracic bioimpedance system may offer possibilities for reducing HF readmissions by enabling identification and treatment of outpatients at risk for readmission.

Intra-Aortic Balloon Pumping in Acute Decompensated Heart Failure With Hypoperfusion: From Pathophysiology to Clinical Practice

2021 ◽  
Author(s):  
Luca Baldetti ◽  
Matteo Pagnesi ◽  
Mario Gramegna ◽  
Alessandro Belletti ◽  
Alessandro Beneduce ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Cardiac Output ◽  
Cardiogenic Shock ◽  
Acute Decompensated Heart Failure ◽  
Therapeutic Option ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Ventricular Afterload ◽  
Clinical Scenarios

Trials on intra-aortic balloon pump (IABP) use in cardiogenic shock related to acute myocardial infarction have shown disappointing results. The role of IABP in cardiogenic shock treatment remains unclear, and new (potentially more potent) mechanical circulatory supports with arguably larger device profile are emerging. A reappraisal of the physiological premises of intra-aortic counterpulsation may underpin the rationale to maintain IABP as a valuable therapeutic option for patients with acute decompensated heart failure and tissue hypoperfusion. Several pathophysiological features differ between myocardial infarction- and acute decompensated heart failure–related hypoperfusion, encompassing cardiogenic shock severity, filling status, systemic vascular resistances rise, and adaptation to chronic (if preexisting) left ventricular dysfunction. IABP combines a more substantial effect on left ventricular afterload with a modest increase in cardiac output and would therefore be most suitable in clinical scenarios characterized by a disproportionate increase in afterload without profound hemodynamic compromise. The acute decompensated heart failure syndrome is characterized by exquisite afterload-sensitivity of cardiac output and may be an ideal setting for counterpulsation. Several hemodynamic variables have been shown to predict response to IABP within this scenario, potentially guiding appropriate patient selection. Finally, acute decompensated heart failure with hypoperfusion may frequently represent an end stage in the heart failure history: IABP may provide sufficient hemodynamic support and prompt end-organ function recovery in view of more definitive heart replacement therapies while preserving ambulation when used with a transaxillary approach.

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