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Clinical Management of Cardiogenic Shock: New Perspectives
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Clinical Management of Cardiogenic Shock: New Perspectives

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 October 2022) | Viewed by 12826

Special Issue Editor

Dr. Joseph E. Tonna

E-Mail Website
Guest Editor
School of Medicine, University of Utah, Salt Lake City, UT, USA
Interests: cardiogenic shock; cardiac arrest; extracorporeal life support; extracorporeal membrane oxygenation

Special Issue Information

Dear Colleagues,

Cardiogenic shock (CS) is a prevalent and highly mortal condition, which has had minimal change in mortality over the previous decades. Complicating acute myocardial infarction, chronic heart failure/cardiomyopathy and post cardiotomy, CS imparts a ~50% mortality. CS remains difficult to treat, in part due to the imprecision in diagnosis and the evolving understanding of severity staging. These limitations make it difficult to standardize patients across studies and consistently identify patients within and across clinical trials. Treatment options for cardiogenic shock are few, both pharmacological and mechanical; previous trials of mechanical circulatory support (MCS) have failed to show significant benefit, and others have struggled to enroll patients, tempering excitement for further study. Pharmacological therapy is universally used, but potentially injurious. Other types of MCS, including peripherally inserted ventricular assist devices (pVADs) and extracorporeal membrane oxygenation (ECMO) are promising but have not been tested in randomized clinical trials.

In this Special Issue, we solicit manuscripts that address a range of clinical aspects of acute cardiogenic shock, such as diagnosis, treatment and management, including pharmacologic and mechanical approaches, and outcomes. We welcome manuscripts that add to the clinical understanding of this highly morbid disease.

Dr. Joseph E. Tonna
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • cardiogenic shock
  • heart failure
  • acute myocardial infarction
  • extracorporeal life support
  • extracorporeal membrane oxygenation
  • cardiac arrest

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Published Papers (5 papers)

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Research

11 pages, 2576 KiB  
Article
Planned Combo Strategy for LVAD Implantation in ECMO Patients: A Proof of Concept to Face Right Ventricular Failure
by Vincenzo Tarzia, Matteo Ponzoni, Demetrio Pittarello and Gino Gerosa
J. Clin. Med. 2022, 11(23), 7062; https://doi.org/10.3390/jcm11237062 - 29 Nov 2022
Cited by 3 | Viewed by 2843
Abstract
We propose a patient-tailored strategy that considers the risk for postoperative right heart failure, utilizing the percutaneous ProtekDuo cannula (Livanova, London, UK) in an innovative way to perform cardiopulmonary bypass during LVAD implantation in ECMO patients. Our novel protocol is based on the [...] Read more.
We propose a patient-tailored strategy that considers the risk for postoperative right heart failure, utilizing the percutaneous ProtekDuo cannula (Livanova, London, UK) in an innovative way to perform cardiopulmonary bypass during LVAD implantation in ECMO patients. Our novel protocol is based on the early intra-operative use of the ProtekDuo cannula, adopting the distal lumen as the pulmonary vent and the proximal lumen as the venous inflow cannula during cardiopulmonary bypass. This configuration is rapidly switched to the standard fashion to provide planned postoperative temporary right ventricular support, in selected patients at high risk of right ventricular failure. From September 2020 to June 2022, six patients were supported with the ProtekDuo cannula during and after an intracorporeal LVAD implantation (five of which were minimally invasive): four HeartMate III (Abbott, U.S.A.) and two HVAD (Medtronic Inc, MN). In all cases, the ProtekDuo cannula was correctly positioned and removed without complications after a median period of 8 days. Non-fatal bleeding (bronchial hemorrhage) occurred in one patient (17%) during biventricular support. Thirty-day mortality was 0%. From this preliminary work, our novel strategy demonstrated to be a feasible solution for planned minimally invasive right ventricular support in ECMO patients scheduled for a durable LVAD implantation. Full article
(This article belongs to the Special Issue Clinical Management of Cardiogenic Shock: New Perspectives)
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7 pages, 213 KiB  
Article
Effect of Portable, In-Hospital Extracorporeal Membrane Oxygenation on Clinical Outcomes
by Anna L. Ciullo, Natalie Wall, Iosif Taleb, Antigone Koliopoulou, Kathleen Stoddard, Stavros G. Drakos, Fred G. Welt, Matthew Goodwin, Nate Van Dyk, Hiroshi Kagawa, Stephen H. McKellar, Craig H. Selzman and Joseph E. Tonna
J. Clin. Med. 2022, 11(22), 6802; https://doi.org/10.3390/jcm11226802 - 17 Nov 2022
Cited by 2 | Viewed by 2106
Abstract
The time between onset of cardiogenic shock and initiation of mechanical circulatory support is inversely related to patient survival as delays in transporting patients to the operating room (OR) for venoarterial extracorporeal membrane oxygenation (VA ECMO) could prove fatal. A primed and portable [...] Read more.
The time between onset of cardiogenic shock and initiation of mechanical circulatory support is inversely related to patient survival as delays in transporting patients to the operating room (OR) for venoarterial extracorporeal membrane oxygenation (VA ECMO) could prove fatal. A primed and portable VA ECMO system may allow faster initiation of ECMO in various hospital locations and subsequently improve outcomes for patients in cardiogenic shock. We reviewed our institutional experience with VA ECMO based on two time periods: beginning of our VA ECMO program and from initiation of our primed and portable in-hospital ECMO system. The primary endpoint was patient survival to discharge. A total of 137 patients were placed on VA ECMO during the study period; n = 66 (48%) before and n = 71 (52%) after program initiation. In the second era, the proportion of OR ECMO initiation decreased significantly (from 92% to 49%, p < 0.01) as more patients received ECMO in other hospital units, including the emergency department (p < 0.01) and during cardiac arrest (12% vs. 38%, p < 0.01). Survival to hospital discharge was equivalent between the two groups (30% vs. 42%, p = 0.1) despite more patients being placed on ECMO during ongoing cardiac arrest. Finally, we observed increased clinical volume since initiation of the in-hospital, portable ECMO system. Developing an in-hospital, primed and portable VA ECMO program resulted in increased clinical volume with equivalent patient survival despite a sicker cohort of patients. We conclude that more rapid deployment of VA ECMO may extend the treatment eligibility to more patients and improve patient outcomes. Full article
(This article belongs to the Special Issue Clinical Management of Cardiogenic Shock: New Perspectives)
11 pages, 947 KiB  
Article
Prognostic Factors in Patients with Sudden Cardiac Arrest and Acute Myocardial Infarction Undergoing Percutaneous Interventions with the LUCAS-2 System for Mechanical Cardiopulmonary Resuscitation
by Michał Chyrchel, Przemysław Hałubiec, Olgerd Duchnevič, Agnieszka Łazarczyk, Michał Okarski, Rafał Januszek, Łukasz Rzeszutko, Stanisław Bartuś and Andrzej Surdacki
J. Clin. Med. 2022, 11(13), 3872; https://doi.org/10.3390/jcm11133872 - 4 Jul 2022
Cited by 1 | Viewed by 1903
Abstract
Sudden cardiac arrest (SCA) is one of the most perilous complications of acute myocardial infarction (AMI). For years, the return of spontaneous circulation (ROSC) has had to be achieved before the patient could be treated at the catheterization laboratory, as simultaneous manual chest [...] Read more.
Sudden cardiac arrest (SCA) is one of the most perilous complications of acute myocardial infarction (AMI). For years, the return of spontaneous circulation (ROSC) has had to be achieved before the patient could be treated at the catheterization laboratory, as simultaneous manual chest compression and angiography were mutually exclusive. Mechanical chest compression devices enabled simultaneous resuscitation and invasive percutaneous procedures. The aim was to characterize the poorer responders that would allow one to predict the positive outcome of such a treatment. We retrospectively analyzed the medical charts of 94 patients with SCA due to AMI, who underwent mechanical cardiopulmonary resuscitation during angiography. In total, 48 patients, 8 (17%) of which survived the event, were included in the final analysis, which revealed that 83% of the survivors had mild to moderate hyperkalemia (potassium 5.0–6.0 mmol/L), in comparison to 15% of non-survivors (p = 0.002). In the age- and sex-adjusted model, patients with serum potassium > 5.0 mmol/L had 4.61-times higher odds of survival until discharge from the hospital (95% CI: 1.41–15.05, p = 0.01). Using the highest Youden index, we identified the potassium concentration of 5.1 mmol/L to be the optimal cut-off value for prediction of survival until hospital discharge (83.3% sensitivity and 87.9% specificity). The practical implications of these findings are that patients with potassium levels between 5.0 and 6.0 mmol/L may actually benefit most from percutaneous coronary interventions with ongoing mechanical chest compressions and that they do not need immediate correction for this electrolyte abnormality. Full article
(This article belongs to the Special Issue Clinical Management of Cardiogenic Shock: New Perspectives)
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11 pages, 851 KiB  
Article
Non-STEMI vs. STEMI Cardiogenic Shock: Clinical Profile and Long-Term Outcomes
by María José Martínez, Ferran Rueda, Carlos Labata, Teresa Oliveras, Santiago Montero, Marc Ferrer, Nabil El Ouaddi, Jordi Serra, Josep Lupón, Antoni Bayés-Genís and Cosme García-García
J. Clin. Med. 2022, 11(12), 3558; https://doi.org/10.3390/jcm11123558 - 20 Jun 2022
Cited by 11 | Viewed by 3845
Abstract
Cardiogenic shock (CS) is a severe complication of acute myocardial infarction (AMI). In AMI-CS, the ST segment deviation on ECG may be elevated (STEMI-CS) or non-elevated (NSTEMI-CS), which may influence prognosis. Our aim was to analyze the clinical profile, acute-phase prognosis, and long-term [...] Read more.
Cardiogenic shock (CS) is a severe complication of acute myocardial infarction (AMI). In AMI-CS, the ST segment deviation on ECG may be elevated (STEMI-CS) or non-elevated (NSTEMI-CS), which may influence prognosis. Our aim was to analyze the clinical profile, acute-phase prognosis, and long-term outcomes of CS relative to the ST pattern on admission. In a prospective registry of 4647 AMI patients admitted to the intensive cardiac care unit of a university hospital between 2010 and 2019, we compared the clinical characteristics, 30-days case fatality, and long-term outcomes of AMI-CS, based on the presence of ST-segment deviation. AMI-CS developed in 239 (5.1%) patients (26.4% women): 190 (79.5%) STEMI-CS and 49 (20.5%) NSTEMI-CS. The mean age was 69.7 years. The STEMI-CS patients had larger infarcts and more mechanical complications than the NSTEMI-CS patients. The NSTEMI-CS patients had a greater prevalence of hypertension, diabetes, peripheral vascular disease, previous cardiovascular comorbidities, three-vessel disease, and left main disease than the STEMI-CS patients. The STEMI-CS patients had higher 30-day mortality than the NSTEMI-CS (59.5% vs. 36.7%; p = 0.004), even after multivariable adjustment (HR 1.91; 95% CI 1.16–3.14), but no differences in mortality were observed at 3 years. In conclusion, the 30-day case-fatality is higher in STEMI-CS, but the long-term outcome is similar in both groups. Full article
(This article belongs to the Special Issue Clinical Management of Cardiogenic Shock: New Perspectives)
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10 pages, 705 KiB  
Article
Incidence and Outcome of Patients with Cardiogenic Shock and Detection of Herpes Simplex Virus in the Lower Respiratory Tract
by Clemens Scherer, Enzo Lüsebrink, Leonhard Binzenhöfer, Thomas J. Stocker, Danny Kupka, Hieu Phan Chung, Era Stambollxhiu, Ahmed Alemic, Antonia Kellnar, Simon Deseive, Konstantin Stark, Tobias Petzold, Christian Hagl, Jörg Hausleiter, Steffen Massberg and Martin Orban
J. Clin. Med. 2022, 11(9), 2351; https://doi.org/10.3390/jcm11092351 - 22 Apr 2022
Cited by 1 | Viewed by 1604
Abstract
(1) Herpes simplex virus (HSV) reactivation in critically ill patients can cause infection in the lower respiratory tract, prolonging mechanical ventilation. However, the association of HSV reactivation with cardiogenic shock (CS) is unclear. As CS is often accompanied by pulmonary congestion and reduced [...] Read more.
(1) Herpes simplex virus (HSV) reactivation in critically ill patients can cause infection in the lower respiratory tract, prolonging mechanical ventilation. However, the association of HSV reactivation with cardiogenic shock (CS) is unclear. As CS is often accompanied by pulmonary congestion and reduced immune system activity, the aim of our study was to determine the incidence and outcome of HSV reactivation in these patients. (2) In this retrospective, single-center study, bronchial lavage (BL) was performed on 181 out of 837 CS patients with mechanical ventilation. (3) In 44 of those patients, HSV was detected with a median time interval of 11 days since intubation. The occurrence of HSV was associated with an increase in C-reactive protein and the fraction of inspired oxygen at the time of HSV detection. Arterial hypertension, bilirubin on ICU admission, the duration of mechanical ventilation and out-of-hospital cardiac arrest were associated with HSV reactivation. (4) HSV reactivation could be detected in 24.3% of patients with CS on whom BL was performed, and its occurrence should be considered in patients with prolonged mechanical ventilation. Due to the limited current evidence, the initiation of treatment for these patients remains an individual choice. Dedicated randomized studies are necessary to investigate the efficacy of antiviral therapy. Full article
(This article belongs to the Special Issue Clinical Management of Cardiogenic Shock: New Perspectives)
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