Acute heart failure and cardiogenic shock: a multidisciplinary practical guidance

Mebazaa, Alexandre; Tolppanen, Heli; Müeller, Christian; Lassus, Johan; DiSomma, Salvatore; Bakšytė, Giedrė; Cecconi, Maurizio; Choi, Dong Ju; Solal, Alain Cohen; Christ, Michael; Masip, Josep; Arrigo, Mattia; Nouira, Semir; Ojji, Dike; Peacock, W. Frank; Richards, Mark; Sato, Naoki; Sliwa, Karen; Špinar, Jindřich; Thiele, Holger; Yilmaz, Mehmet Birhan; Januzzi, James L.

doi:10.1007/s00134-015-4041-5

Cited by 150 publications

(120 citation statements)

References 100 publications

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“…Mechanical circulatory support may be necessary to prevent irreversible end-organ damage in cardiogenic shock (CS) [1,2]. For more than 40 years, the intra-aortic balloon pump (IABP) has been used in CS to improve coronary and peripheral perfusion via diastolic balloon inflation and to augment left ventricular (LV) performance via systolic balloon deflation through a decreased afterload [3,4].…”

Section: Introductionmentioning

confidence: 99%

First-Line Support by Intra-Aortic Balloon Pump in Non-Ischaemic Cardiogenic Shock in the Era of Modern Ventricular Assist Devices

et al. 2017

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Objectives: Little is known about circulatory support in cardiogenic shock (CS) from other causes than the acute coronary syndrome or after cardiotomy. We evaluated the effects of first-line intra-aortic balloon pump (IABP) support in this subpopulation of CS patients. Methods: A retrospective study was performed in 27 patients with CS from end-stage cardiomyopathy supported firstly by IABP in the years 2011-2016. Results: At 24 h, lactate decreased from 3.2 (2.1-6.8) to 1.8 (1.2-2.2) mmol/L (p < 0.001).Eighteen patients (67%) defined as IABP responders were successfully bridged to either recovery (n = 7), left ventricular assist device (n = 5), or heart transplantation (n = 6). IABP failed in 9 patients (non-responders, 33%) who either died (n = 7) or needed support by extracorporeal membrane oxygenation (n = 2). At 24 h of IABP support, urinary output was higher (2,660 [1,835-4,440] vs. 1,200 [649-2,385] mL; p = 0.02) and fluid balance more negative (-1,564 [-2,673 to -1,086] vs. -500 [-930 to +240] mL; p < 0.001) in responders than non-responders. Overall survival at 1 year was 63%. Conclusion: In most patients, first-line support by IABP in end-stage cardiomyopathy is associated with improvement in organ perfusion and clinical stabilisation for at least 24 h allowing time for decision making on next therapies.

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Section: Introductionmentioning

confidence: 99%

First-Line Support by Intra-Aortic Balloon Pump in Non-Ischaemic Cardiogenic Shock in the Era of Modern Ventricular Assist Devices

et al. 2017

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“…Furthermore, the sickest patients were excluded in this trial [44]. For daily practice it is of utmost interest to know which vasopressor, inotrope, vasodilator or any combination is indicated for which patient and at what target [56, 57]. We found that for milrinone and levosimendan for critically ill adult patients with cardiac dysfunction evidence from trials with low risk of bias and low risk of random error is lacking to support its use [58].…”

Section: Discussionmentioning

confidence: 99%

Milrinone for cardiac dysfunction in critically ill adult patients: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis

et al. 2016

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IntroductionMilrinone is an inotrope widely used for treatment of cardiac failure. Because previous meta-analyses had methodological flaws, we decided to conduct a systematic review of the effect of milrinone in critically ill adult patients with cardiac dysfunction.MethodsThis systematic review was performed according to The Cochrane Handbook for Systematic Reviews of Interventions. Searches were conducted until November 2015. Patients with cardiac dysfunction were included. The primary outcome was serious adverse events (SAE) including mortality at maximum follow-up. The risk of bias was evaluated and trial sequential analyses were conducted. The quality of evidence was assessed by the Grading of Recommendations Assessment, Development and Evaluation criteria.ResultsA total of 31 randomised clinical trials fulfilled the inclusion criteria, of which 16 provided data for our analyses. All trials were at high risk of bias, and none reported the primary composite outcome SAE. Fourteen trials with 1611 randomised patients reported mortality data at maximum follow-up (RR 0.96; 95% confidence interval 0.76–1.21). Milrinone did not significantly affect other patient-centred outcomes. All analyses displayed statistical and/or clinical heterogeneity of patients, interventions, comparators, outcomes, and/or settings and all featured missing data.DiscussionThe current evidence on the use of milrinone in critically ill adult patients with cardiac dysfunction suffers from considerable risks of both bias and random error and demonstrates no benefits. The use of milrinone for the treatment of critically ill patients with cardiac dysfunction can be neither recommended nor refuted. Future randomised clinical trials need to be sufficiently large and designed to have low risk of bias.Electronic supplementary materialThe online version of this article (doi:10.1007/s00134-016-4449-6) contains supplementary material, which is available to authorized users.

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“…The routine AHF management includes 12‐lead electrocardiogram (ECG) recording, vital sign monitoring, option for treatment with supplementary oxygen, non‐invasive ventilation (NIV), and administration of IV diuretics and vasodilators . However, the administration of pre‐hospital medication seems scarce .…”

Section: Introductionmentioning

confidence: 99%

Pre‐hospital management protocols and perceived difficulty in diagnosing acute heart failure

Miró

Martín‐Sánchez

et al. 2019

ESC Heart Failure

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Aim To illustrate the pre‐hospital management arsenals and protocols in different EMS units, and to estimate the perceived difficulty of diagnosing suspected acute heart failure (AHF) compared with other common pre‐hospital conditions. Methods and results A multinational survey included 104 emergency medical service (EMS) regions from 18 countries. Diagnostic and therapeutic arsenals related to AHF management were reported for each type of EMS unit. The prevalence and contents of management protocols for common medical conditions treated pre‐hospitally was collected. The perceived difficulty of diagnosing AHF and other medical conditions by emergency medical dispatchers and EMS personnel was interrogated. Ultrasound devices and point‐of‐care testing were available in advanced life support and helicopter EMS units in fewer than 25% of EMS regions. AHF protocols were present in 80.8% of regions. Protocols for ST‐elevation myocardial infarction, chest pain, and dyspnoea were present in 95.2, 80.8, and 76.0% of EMS regions, respectively. Protocolized diagnostic actions for AHF management included 12‐lead electrocardiogram (92.1% of regions), ultrasound examination (16.0%), and point‐of‐care testings for troponin and BNP (6.0 and 3.5%). Therapeutic actions included supplementary oxygen (93.2%), non‐invasive ventilation (80.7%), intravenous furosemide, opiates, nitroglycerine (69.0, 68.6, and 57.0%), and intubation 71.5%. Diagnosing suspected AHF was considered easy to moderate by EMS personnel and moderate to difficult by emergency medical dispatchers (without significant differences between de novo and decompensated heart failure). In both settings, diagnosis of suspected AHF was considered easier than pulmonary embolism and more difficult than ST‐elevation myocardial infarction, asthma, and stroke. Conclusions The prevalence of AHF protocols is rather high but the contents seem to vary. Difficulty of diagnosing suspected AHF seems to be moderate compared with other pre‐hospital conditions.

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Acute heart failure and cardiogenic shock: a multidisciplinary practical guidance

Cited by 150 publications

References 100 publications

First-Line Support by Intra-Aortic Balloon Pump in Non-Ischaemic Cardiogenic Shock in the Era of Modern Ventricular Assist Devices

First-Line Support by Intra-Aortic Balloon Pump in Non-Ischaemic Cardiogenic Shock in the Era of Modern Ventricular Assist Devices

Milrinone for cardiac dysfunction in critically ill adult patients: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis

Pre‐hospital management protocols and perceived difficulty in diagnosing acute heart failure

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