Author + information
- Behnam Tehrani1,
- Alexander Truesdell2,
- Ramesh Singth3,
- Patricia Saulino3,
- Scott Barnett3,
- Paul Gurbel4,
- Charles Murphy3 and
- Christopher O'Connor5
- 1Inova Heart and Vascular Institute, Annandale, Virginia, United States
- 2Virginia Heart, McLean, Virginia, United States
- 3Inova Heart and Vascular Institute, Falls Church, Virginia, United States
- 4Inova heart and vascular institute, Baltimore, Maryland, United States
- 5Inova Heart and Vascular Institute, Falls Church, Virginia, United States
Cardiogenic shock (CS) is a hemodynamically complex syndrome associated with multisystem organ failure and high morbidity/mortality. Despite advances in early reperfusion and mechanical circulatory support ( MCS), treatment remains highly variable. We present longitudinal outcomes of a single center high volume CS program using an innovative team-based approach to reduce practice variation by focusing on standardized protocols.
172 consecutive patients entered our institution with a diagnosis of CS from January 3, 2017 (the start date of our CS Team). The etiology of CS and survival to discharge were determined. We also assessed age, sex, presence of right heart catheterization (RHC), and time from shock diagnosis to MCS. Serum lactate, cardiac power output (CPO) and pulmonary arterial pulsatility index (PAPi) were also analyzed at baseline, 12 and 24 hours post-CS diagnosis. Threshold cutpoints were determined at 12 hours for lactate (< 3.0 mmol/dL), CPO (>0.6 W), and PAPi (> 1.0).
Compared to 2016 survival rate of 47.0%, from 2017 to 2018 survival rates increased to 57.9% and 81.3% respectively (p<0.01). Survival increased from 52.6% to 75.0% (p<0.118) in Acute MI CS and from 61.4% to 87.5% (p<0.045) in acute decompensated HF CS. For CS threshold markers at 12 hours (lactate <3.0 mmol/L, CPO >0.6W, PAPi >1.0) overall survival was 82.8%, 93.2% and 76.4%, and use of RHC was associated with 14% greater survival (Figure). Reductions of 5 and 10 hours in time to implement MCS were associated with increased survival (53.6% and 135.8%, respectively). Age was also associated with survival (p<0.018); patients ≥75 years old had higher risk of death (OR: 3.43; 95% CI: 1.20-9.78).
Our observational study provides evidence that a team-based approach focused on timely diagnosis, mandatory invasive hemodynamics and appropriate MCS use may improve outcomes in cardiogenic shock.
CORONARY: Hemodynamic Supportand Cardiogenic Shock