Cardiogenic Shock – Developments and Treatment Strategies

2009 ◽  
Vol 5 (2) ◽  
pp. 48 ◽  
Author(s):  
Ricardo Seabra-Gomes ◽  
Jorge Ferreira ◽  
◽  
Keyword(s):  
Cardiogenic Shock ◽  
Early Recognition ◽  
Treatment Strategies ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Significant Treatment ◽  
Ventricular Assist ◽  
Hard Data ◽  
Oxide Synthase

Cardiogenic shock remains one of the most serious and challenging conditions in cardiology and is responsible for the highest in-hospital mortality associated with ST-elevation myocardial infarction. The only significant treatment strategy that has been shown to reduce its incidence and inherent mortality is emergent coronary revascularisation. Prevention should aim at early recognition of symptoms, appropriate pre-hospital emergency medical care and prompt primary revascularisation. Once established, cardiogenic shock still has an unacceptably high mortality rate. Approaches that include new pharmacological therapies and other forms of mechanical haemodynamic support are under investigation. The possible role of systemic inflammatory response has led to the investigation of nitric oxide synthase inhibition, although initial results with tilarginine were disappointing. The use of percutaneous left ventricular assist devices looks promising, but hard data regarding mortality benefit are still missing. Cardiogenic shock remains a perplexing and often fatal condition. The future may require more basic, translational and clinical research.

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

2020 ◽  
Vol 9 (4) ◽  
pp. 931 ◽  
Author(s):  
Benedikt Schrage ◽  
Jessica Weimann ◽  
Salim Dabboura ◽  
Isabell Yan ◽  
Rafel Hilal ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Cox Regression ◽  
Treatment Strategies ◽  
Patient Characteristics ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist

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.

Devices for Transcatheter Haemodynamic Support for Left Heart Failure

2010 ◽  
Vol 5 (1) ◽  
pp. 16
Author(s):  
Aman Ali ◽  
Timothy A Sanborn ◽  
◽  
Keyword(s):  
Mortality Rate ◽  
Cardiogenic Shock ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Severe Left Ventricular Dysfunction ◽  
Ventricular Assist ◽  
Left Heart Failure ◽  
Assist Devices ◽  
Left Ventricular Assist

Among patients with acute myocardial infarction (AMI), those in cardiogenic shock have the highest mortality rate. Early revascularisation with primary percutaneous intervention or coronary artery bypass surgery has decreased the mortality rate of patients in cardiogenic shock, but it remains high. The conventional treatment of haemodynamic instability has been the use of the intra-aortic balloon pump (IABP); however, the IABP may not give adequate support to patients with severe left ventricular dysfunction. Recent advances in percutaneous left ventricular assist devices, specifically the TandemHeart and Impella LP 2.5, have shown improved haemodynamic support compared with the IABP. This article provides an overview of the use of percutaneous left ventricular assist devices to treat patients presenting with cardiogenic shock after acute MI.

Aortic Regurgitation in Patients with Left Ventricular Assist Devices

2019 ◽  
pp. 338-344
Author(s):  
Marisa Cevasco ◽  
Koji Takeda ◽  
Masahiko Ando ◽  
Yoshifumi Naka
Keyword(s):  
Surgical Techniques ◽  
Treatment Strategies ◽  
Aortic Insufficiency ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Left Ventricular Assist

Aortic insufficiency (AI) occurs as a complication in 25% to 37% of cases that receive left ventricular assist devices (LVAD). The incidence increases after implant by 1% to 6% per month of continued support. Uncertainty remains over the appropriate management of pump speeds to help delay this deterioration (complete emptying versus allowing native ventricular function open the aortic on a regular basis). Significant AI can lead to hemodynamic impairment with adverse outcomes over time. Due to the recirculation of blood, the calculated cardiac output of the LVAD may be markedly skewed. A number of surgical techniques have been proposed for the prevention and management of AI in the setting of LVAD therapy. This chapter details the causes, treatment strategies, and outcomes associated with this complication.

scholarly journals Prediction of survival of patients in cardiogenic shock treated by surgically implanted Impella 5+ short-term left ventricular assist device

2020 ◽  
Vol 31 (4) ◽  
pp. 475-482
Author(s):  
Gaik Nersesian ◽  
Carsten Tschöpe ◽  
Frank Spillmann ◽  
Tom Gromann ◽  
Luise Roehrich ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Circulatory Support ◽  
Left Ventricular Assist Devices ◽  
Short Term ◽  
Ventricular Assist ◽  
Left Ventricular Assist

Abstract OBJECTIVES Short-term mechanical circulatory support is a life-saving treatment for acute cardiogenic shock (CS). This multicentre study investigates the preoperative predictors of 30-day mortality in CS patients treated with Impella 5.0 and 5.5 short-term left ventricular assist devices. METHODS Data of patients in CS (n = 70) treated with the Impella 5 (n = 63) and 5.5 (n = 7) in 2 centres in Berlin between October 2016 and October 2019 were collected retrospectively. RESULTS CS was caused by acute myocardial infarction (n = 16), decompensated chronic heart failure (n = 41), postcardiotomy syndrome (n = 5) and acute myocarditis (n = 8). Before implantation 12 (17%) patients underwent cardiopulmonary resuscitation and 32 (46%) patients were ventilated. INTERMACS level 1, 2 and 3 was established in 35 (50%), 29 (41%) and 6 (9%) of patients, respectively. The mean preoperative lactate level was 4.05 mmol/l. The median support time was 7 days (IR= 4–15). In 18 cases, the pump was removed for myocardial recovery, in 22 cases, durable left ventricular assist devices were implanted, and 30 patients died on support. The overall 30-day survival was 51%. Statistical analysis showed that an increase in lactate per mmol/l [odds ratio (OR) 1.217; P = 0.015] and cardiopulmonary resuscitation before implantation (OR 16.74; P = 0.009) are predictors of 30-day survival. Based on these data, an algorithm for optimal short-term mechanical circulatory support selection is proposed. CONCLUSIONS Impella treatment is feasible in severe CS. Severe organ dysfunction, as well as the level and duration of shock predict early mortality. An algorithm based on these parameters may help identify patients who would benefit from Impella 5+ support.

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