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Clinical Management of Cardiogenic Shock and Cardiac Arrest

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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 (25 August 2024) | Viewed by 8963

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Dr. Jaime A. Hernández-Montfort

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Advanced Heart Disease, Replacement and Recovery Program, Baylor Scott and White Health, Temple, TX, USA
Interests: cardiogenic shock; heart replacement; heart recovery; transitions in mechanical circulatory support
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Dear Colleagues,

Cardiogenic shock remains a complex disease entity associated with high mortality that compromises the well-being of patients and caregivers in healthcare systems around the world. Increased recognition on the spectral nature of cardiogenic shock has led to interdisciplinary management focused on early diagnostic profiles that can inform clinicians on how to tailor specific interventions and transitions. Importantly, severe refractory cardiogenic shock complicated with cardiac arrest carries an exceedingly high mortality and, paradoxically, is where most of the contemporary high-profile resource intensive interventions are oftentimes utilized. In that context, classifications, team-based approaches and systems of care that allow for early recognition of the disease have emerged in an attempt to halt hemometabolic involvement and provide a pathway towards more defined transitions, including heart recovery or remission. Important progress has been made with the use of specific temporary mechanical circulatory support devices tailoring right, left or biventricular support; however, knowledge gaps remain on the multiple associated clinical interventions required to help patients transition to the ultimate goal of achieving longitudinal well-being. Aspects related with decongestion, weaning and escalation of temporary MCS, as well as strategies that promote ambulation, nutrition, and end-organ recovery (including neuroprotection after cardiac arrest), are some of the ongoing clinical questions that need to be addressed to best understand and guide clinicians in this rapidly evolving field. In this Special Issue, we invite authors to submit papers on the clinical advance of management of cardiogenic shock and cardiac arrest.

Dr. Jaime A. Hernández-Montfort
Guest Editor

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Keywords

cardiogenic shock
cardiac arrest
temporary mechanical circulatory support
ECMO
transitions
heart recovery
heart replacement

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Clinical Management of Cardiogenic Shock and Cardiac Arrest: 2nd Edition in Journal of Clinical Medicine

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Research

11 pages, 803 KiB

Open AccessArticle

Use of Intravascular Micro-Axial Left Ventricular Assist Devices as a Bridging Strategy for Cardiogenic Shock: Mid-Term Outcomes

by Balakrishnan Mahesh, Prasanth Peddaayyavarla, Kenny Nguyen, Aditya Mahesh, Corrine Corrina Hartford, Robert Devich, Gianna Dafflisio, Nandini Nair, Miriam Freundt, Robert Dowling and Behzad Soleimani

J. Clin. Med. 2024, 13(22), 6804; https://doi.org/10.3390/jcm13226804 - 12 Nov 2024

Viewed by 390

Abstract

Objectives: Patients in cardiogenic shock (CS) may be successfully bridged using intravascular micro-axial left ventricular assist devices (M-LVADs) for recovery or determination of definitive therapy. Methods: One hundred and seven CS patients implanted with M-LVADs from January 2020 to May 2024 were divided into four groups; group-1: 34 patients (transplant); group-2: 25 patients (LVAD); group-3: 42 patients (postcardiotomy CS (PCCS)); group-4: 6 patients (decision/recovery but excluded from analysis). Multivariable logistic regression and Multivariable Coxregression models identified predictors of early -hospital and late mortality, and Odds ratios (ORs) and hazard ratios (HRs) with p < 0.05, respectively, were considered statistically significant. SPSS 29.0 and Python 3.11.1. were used for analyses. Results: Complications included device-malfunction (6%), gastrointestinal bleed (9%), long-term hemodialysis (21%), axillary hematoma requiring re-exploration (10%), heparin-induced thrombocytopenia (4%) requiring heparin therapy cessation/initiation of argatroban infusion, and non-fatal stroke (11%). Early hospital mortality included 13 patients: 2 in group-1, 1 in group-2, 10 in group-3 (p = 0.02). In the Logistic-Regression model, category of CS requiring an M-LVAD was significant (OR = 4.7, p = 0.05). Patients were followed for 4.5 years (mean follow-up was 23 ± 17 months), and 23 deaths occurred; group-1: 3 patients, group-2: 5 patients, and group-3: 15 patients (p = 0.019). At 4.5 years, actuarial survival was 90.7 ± 5.1% in group-1, 79.2 ± 8.3% in group-2, 62.8 ± 7.7% in group-3 (p = 0.01). In the Cox-Regression model, M-LVAD category (HR = 3.63, p = 0.04), and long-term postoperative dialysis (HR = 3.9, p = 0.002) emerged as predictors of long-term mortality. Conclusions: In cardiogenic shock, mid-term outcomes demonstrate good survival with M-LVADs as bridge to transplant/durable LVADs and reasonable survival with M-LVADs as a bridge to recovery following cardiotomy, accompanied by reduced ECMO usage, and early ambulation/rehabilitation. Full article

(This article belongs to the Special Issue Clinical Management of Cardiogenic Shock and Cardiac Arrest)

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10 pages, 1102 KiB

Open AccessArticle

Provisional Circulatory Support with Extracorporeal Membrane Oxygenation during Ventricular Tachycardia Ablation in Intermediate Risk Patients: A Case Series

by Giuseppe Mascia, Luca Barca, Paolo Sartori, Daniele Bianco, Roberta Della Bona, Paolo Di Donna and Italo Porto

J. Clin. Med. 2024, 13(15), 4477; https://doi.org/10.3390/jcm13154477 - 31 Jul 2024

Viewed by 959

Abstract

Background: Cardiogenic shock with acute hemodynamic decompensation may be one of the most serious risks in patients affected by ventricular tachycardia (VT). Its proper identification may have important implications in terms of pharmacological management, as might procedural planning in case of patients undergoing catheter ablation. Methods: We describe a case series of patients with provisional strategies for circulatory support in VT ablation, including the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) and vascular accesses in the electrophysiology lab but no initial ECMO activation due to an estimated intermediate pre-procedural risk from the case-series population. Results: In total, 10 patients (mean age 70 ± 11 years old, 9 males) with severe cardiomyopathy were admitted for incessant ventricular arrhythmia episodes, further diagnosis, and therapy planning; 1/10 patients (10%), documenting a PAINESD score of 14, underwent VA-ECMO cannulation due to electromechanical dissociation. All 10 patients were discharged alive. Conclusions: A pre-defined strategy before VT ablation is crucial. In our case series, the use of provisional circulatory support with VA-ECMO during incessant ablation of ventricular arrhythmia was a safe and winning alternative to upfront strategies. Full article

(This article belongs to the Special Issue Clinical Management of Cardiogenic Shock and Cardiac Arrest)

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11 pages, 515 KiB

Open AccessArticle

In Patients with Cardiogenic Shock, Extracorporeal Membrane Oxygenation Is Associated with Very High All-Cause Inpatient Mortality Rate

by Mohammad Reza Movahed, Arman Soltani Moghadam and Mehrtash Hashemzadeh

J. Clin. Med. 2024, 13(12), 3607; https://doi.org/10.3390/jcm13123607 - 20 Jun 2024

Cited by 1 | Viewed by 1039

Abstract

Background: The goal of this study was to evaluate the effect of extracorporeal membrane oxygenation (ECMO) on mortality in patients with cardiogenic shock excluding Impella and IABP use. Method: The large Nationwide Inpatient Sample (NIS) database was utilized to study any association between the use of ECMO in adults over the age of 18 and mortality and complications with a diagnosis of cardiogenic shocks. Results: ICD-10 codes for ECMO and cardiogenic shock for the available years 2016–2020 were utilized. A total of 796,585 (age 66.5 ± 14.4) patients had a diagnosis of cardiogenic shock excluding Impella. Of these patients, 13,160 (age 53.7 ± 15.4) were treated with ECMO without IABP use. Total inpatient mortality without any device was 32.7%. It was 47.9% with ECMO. In a multivariate analysis adjusting for 47 variables such as age, gender, race, lactic acidosis, three-vessel intervention, left main myocardial infarction, cardiomyopathy, systolic heart failure, acute ST-elevation myocardial infarction, peripheral vascular disease, chronic renal disease, etc., ECMO utilization remained highly associated with mortality (OR: 1.78, CI: 1.6–1.9, p < 0.001). Evaluating teaching hospitals only revealed similar findings. Major complications were also high in the ECMO cohort. Conclusions: In patients with cardiogenic shock, the use of ECMO was associated with the high in-hospital mortality regardless of comorbid condition, high-risk futures, or type of hospital. Full article

(This article belongs to the Special Issue Clinical Management of Cardiogenic Shock and Cardiac Arrest)

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11 pages, 950 KiB

Open AccessArticle

Impact of the Timing of Mechanical Circulatory Support on the Outcomes in Myocardial Infarction-Related Cardiogenic Shock: Subanalysis of the PREPARE CS Registry

by Dan M. Prunea, Eva Bachl, Lukas Herold, Sadeek S. Kanoun Schnur, Sascha Pätzold, Siegfried Altmanninger-Sock, Gudrun A. Sommer, Theresa Glantschnig, Ewald Kolesnik, Markus Wallner, Klemens Ablasser, Heiko Bugger, Eva Buschmann, Andreas Praschk, Friedrich M. Fruhwald, Albrecht Schmidt, Dirk von Lewinski and Gabor G. Toth

J. Clin. Med. 2024, 13(6), 1552; https://doi.org/10.3390/jcm13061552 - 8 Mar 2024

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Abstract

(1) Background: Mechanical circulatory support (MCS) in myocardial infarction-associated cardiogenic shock is subject to debate. This analysis aims to elucidate the impact of MCS’s timing on patient outcomes, based on data from the PREPARE CS registry. (2) Methods: The PREPARE CS prospective registry includes patients who experienced cardiogenic shock (SCAI classes C–E) and were subsequently referred for cardiac catheterization. Our present analysis included a subset of this registry, in whom MCS was used and who underwent coronary intervention due to myocardial infarction. Patients were categorized into an Upfront group and a Procedural group, depending on the timing of MCS’s introduction in relation to their PCI. The endpoint was in-hospital mortality. (3) Results: In total, 71 patients were included. MCS was begun prior to PCI in 33 (46%) patients (Upfront), whereas 38 (54%) received MCS during or after the initiation of PCI (Procedural). The groups’ baseline characteristics and hemodynamic parameters were comparable. The Upfront group had a higher utilization of the Impella^® device compared to extracorporeal membrane oxygenation (67% vs. 33%), while the Procedural group exhibited a balanced use of both (50% vs. 50%). Most patients suffered from multi-vessel disease in both groups (82% vs. 84%, respectively; p = 0.99), and most patients required a complex PCI procedure; the latter was more prevalent in the Upfront group (94% vs. 71%, respectively; p = 0.02). Their rates of complete revascularization were comparable (52% vs. 34%, respectively; p = 0.16). Procedural CPR was significantly more frequent in the Procedural group (45% vs. 79%, p < 0.05); however, in-hospital mortality was similar (61% vs. 79%, respectively; p = 0.12). (4) Conclusions: The upfront implantation of MCS in myocardial infarction-associated CS did not provide an in-hospital survival benefit. Full article

(This article belongs to the Special Issue Clinical Management of Cardiogenic Shock and Cardiac Arrest)

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13 pages, 1880 KiB

Open AccessArticle

SCAI Staging Application for Acute Myocardial Infarction-Related Cardiogenic Shock at a Single-Center Russian Registry

by Vyacheslav V. Ryabov, Oleg O. Panteleev, Maria A. Kercheva, Alexei A. Gorokhovsky, Anna G. Syrkina and Natalia Y. Margolis

J. Clin. Med. 2023, 12(24), 7739; https://doi.org/10.3390/jcm12247739 - 17 Dec 2023

Cited by 1 | Viewed by 1437

Abstract

Aim: To access the features of the course of myocardial infarction (MI) in patients with different stages of MI complicated by cardiogenic shock (MI CS) according to the SCAI scale. Methods: We retrospectively described the portrait of CS MI (n = 117) at different stages of SCAI from the hospital MI registry (n = 1253). Results: Hospital mortality increased from stage to stage (p ≤ 0.001). Significant differences in biochemical parameters were found both for indicators characterizing intensive care measures, such as the presence of mechanical lung ventilation or an intra-aortic balloon pump, and for indicators of organ hypoperfusion such as lactate level, pHv (7.39 (7.36; 7.44) at stage A–B; 7.14 (7.06; 7.18) at stage E), creatinine, and glomerular filtration rate. Parameters related to MI characteristics, such as instrumental and laboratory data, anamnesis of ischemia, and performed treatment, did not differ between groups. Polynomial logistic regression showed that lactate level, mechanical ventilation, and monocyte count upon admission (1.15 (0.96; 1.23) at stage A–B; 0.78 (0.49; 0.94) at stage E, p = 0.005) correlated with CS severity. Conclusion: The characteristics of MI at different stages of SCAI do not have differences and do not determine the severity of shock. We revealed a high discriminatory potential of the pH level in predicting refractory shock. The value of monocytes at admission may be a promising predictor of the severity of MI CS. The question of the causes of heterogeneity of MI CS, taking into account the homogeneity of MI characteristics, remains open and promising. Full article

(This article belongs to the Special Issue Clinical Management of Cardiogenic Shock and Cardiac Arrest)

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21 pages, 1591 KiB

Open AccessArticle

Invasive Phenoprofiling of Acute-Myocardial-Infarction-Related Cardiogenic Shock

by Jorge A. Ortega-Hernández, Héctor González-Pacheco, Jardiel Argüello-Bolaños, José Omar Arenas-Díaz, Roberto Pérez-López, Mario Ramón García-Arias, Rodrigo Gopar-Nieto, Daniel Sierra-Lara-Martínez, Diego Araiza-Garaygordobil, Daniel Manzur-Sandoval, Luis Alejandro Soliz-Uriona, Gloria Monserrath Astudillo-Alvarez, Jaime Hernández-Montfort and Alexandra Arias-Mendoza

J. Clin. Med. 2023, 12(18), 5818; https://doi.org/10.3390/jcm12185818 - 7 Sep 2023

Cited by 1 | Viewed by 1573

Abstract

Background: Studies had previously identified three cardiogenic shock (CS) phenotypes (cardiac-only, cardiorenal, and cardiometabolic). Therefore, we aimed to understand better the hemodynamic profiles of these phenotypes in acute myocardial infarction-CS (AMI-CS) using pulmonary artery catheter (PAC) data to better understand the AMI-CS heterogeneity. Methods: We analyzed the PAC data of 309 patients with AMI-CS. The patients were classified by SCAI shock stage, congestion profile, and phenotype. In addition, 24 h hemodynamic PAC data were obtained. Results: We identified three AMI-CS phenotypes: cardiac-only (43.7%), cardiorenal (32.0%), and cardiometabolic (24.3%). The cardiometabolic phenotype had the highest mortality rate (70.7%), followed by the cardiorenal (52.5%) and cardiac-only (33.3%) phenotypes, with significant differences (p < 0.001). Right atrial pressure (p = 0.001) and pulmonary capillary wedge pressure (p = 0.01) were higher in the cardiometabolic and cardiorenal phenotypes. Cardiac output, index, power, power index, and cardiac power index normalized by right atrial pressure and left-ventricular stroke work index were lower in the cardiorenal and cardiometabolic than in the cardiac-only phenotypes. We found a hazard ratio (HR) of 2.1 for the cardiorenal and 3.3 for cardiometabolic versus the cardiac-only phenotypes (p < 0.001). Also, multi-organ failure, acute kidney injury, and ventricular tachycardia/fibrillation had a significant HR. Multivariate analysis revealed that CS phenotypes retained significance (p < 0.001) when adjusted for the Society for Cardiovascular Angiography & Interventions score (p = 0.011) and ∆congestion (p = 0.028). These scores independently predicted mortality. Conclusions: Accurate patient prognosis and treatment strategies are crucial, and phenotyping in AMI-CS can aid in this effort. PAC profiling can provide valuable prognostic information and help design new trials involving AMI-CS. Full article

(This article belongs to the Special Issue Clinical Management of Cardiogenic Shock and Cardiac Arrest)

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18 pages, 1132 KiB

Open AccessEditor’s ChoiceArticle

Characteristics, Treatment Strategies and Outcome in Cardiogenic Shock Complicating Acute Myocardial Infarction: A Contemporary Dutch Cohort

by Elma J. Peters, Sanne ten Berg, Margriet Bogerd, Marijke J. C. Timmermans, Adriaan O. Kraaijeveld, Jeroen J. H. Bunge, Koen Teeuwen, Erik Lipsic, Krischan D. Sjauw, Robert-Jan M. van Geuns, Admir Dedic, Eric A. Dubois, Martijn Meuwissen, Peter Danse, Niels J. W. Verouden, Gabe Bleeker, José M. Montero Cabezas, Irlando A. Ferreira, Annemarie E. Engström, Wim K. Lagrand, Luuk C. Otterspoor, Alexander P. J. Vlaar, José P. S. Henriques and on behalf of the Participating Centers of the PCI Registration Committee of the Netherlands Heart Registration Show full author list Hide full author list

J. Clin. Med. 2023, 12(16), 5221; https://doi.org/10.3390/jcm12165221 - 10 Aug 2023

Cited by 8 | Viewed by 1503

Abstract

Cardiogenic shock (CS) complicating acute myocardial infarction (AMI) is associated with high morbidity and mortality. Our study aimed to gain insights into patient characteristics, outcomes and treatment strategies in CS patients. Patients with CS who underwent percutaneous coronary intervention (PCI) between 2017 and 2021 were identified in a nationwide registry. Data on medical history, laboratory values, angiographic features and outcomes were retrospectively assessed. A total of 2328 patients with a mean age of 66 years and of whom 73% were male, were included. Mortality at 30 days was 39% for the entire cohort. Non-survivors presented with a lower mean blood pressure and increased heart rate, blood lactate and blood glucose levels (p-value for all <0.001). Also, an increased prevalence of diabetes, multivessel coronary artery disease and a prior coronary event were found. Of all patients, 24% received mechanical circulatory support, of which the majority was via intra-aortic balloon pumps (IABPs). Furthermore, 79% of patients were treated with at least one vasoactive agent, and multivessel PCI was performed in 28%. In conclusion, a large set of hemodynamic, biochemical and patient-related characteristics was identified to be associated with mortality. Interestingly, multivessel PCI and IABPs were frequently applied despite a lack of evidence. Full article

(This article belongs to the Special Issue Clinical Management of Cardiogenic Shock and Cardiac Arrest)

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