Management of Cardiogenic Shock in a Cardiac Intensive Care Unit

Kim, Ju H.; Sunkara, Anusha; Varnado, Sara

doi:10.14797/mdcj-16-1-36

Cited by 13 publications

(12 citation statements)

References 42 publications

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“…This study developed the CSP score which classified CS patients into three risk groups: scores of <115 were determined to be low-risk (0% mortality), scores of 116–209 as medium-risk (8.75% mortality), and more than 210 as high-risk (66.67% mortality). The condition of patients with CS lies on a continuum, progressing from pre-shock states to severe shock states at different rates and requiring simultaneous interventions to maintain hemodynamic stability ( 2 , 6 ). This study takes this into consideration and identified predictive factors for mortality risk within 72 h of acute care management or immediately after admission for more accurate prognostication.…”

Section: Discussionmentioning

confidence: 99%

“…The CardShock study enrolled patients with all etiologies of CS, but more than half were acute CS (ACS) cases (5). The epidemiology of shock has evolved in recent years with AMI-related CS (AMICS) accounting for less than one-third of all CS cases, hence the role of hemodynamic stabilization using pharmacologic and nonpharmacologic therapies has been inconsistent (6,7). All these risk scores revealed modest prognostic accuracy, with an internal validation area under the curve (AUC) of.74, 0.79, and.71, respectively (3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

“…Thus factors during a patient's acute care management may also affect the prognosis ( 2 , 8 ). Besides, optimal management of CS requires timely interventions to prevent multiorgan system dysfunction ( 6 ). Early classification of CS may be needed to stratify illness severity to provide appropriate treatments and improve outcomes.…”

Section: Introductionmentioning

confidence: 99%

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The CSP (Cardiogenic Shock Prognosis) Score: A Tool for Risk Stratification of Cardiogenic Shock

Tien

Chen

Huang

et al. 2022

Front. Cardiovasc. Med.

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BackgroundCardiogenic shock (CS) is a critical condition and the leading cause of mortality after acute myocardial infarction (AMI). Scores that predict mortality have been established, but a patient's clinical course is often nonlinear. Thus, factors present during acute care management may be explored. This study intended to develop a risk-predictive model for patients with CS.MethodsIn this observational study, adult patients who received inotropic support at the Emergency Room (ER) from January 2017 to August 2020 and were admitted to the cardiac care unit (CCU) with a diagnosis of CS were enrolled in this study. Patients with out-of-hospital cardiac arrest, inotropic support for bradycardia, and survival <24 h after ER arrival were excluded. A total of 311 patients were enrolled and categorized into derivation (n = 243) and validation (n = 68) cohorts.ResultsA history of coronary artery disease, multiple inotrope use, ejection fraction <40%, lower hemoglobin concentration, longer cardiopulmonary resuscitation duration, albumin infusion, and renal replacement therapy were identified as independent prognostic factors for in-hospital mortality. The cardiogenic shock prognosis (CSP) score was established as a nomogram and three risk groups were identified: low-risk (score 115, 0% of mortality), medium-risk (score 116–209, 8.75% of mortality), and high-risk (score 210, 66.67% of mortality). The area-under-the-curve (AUC) of the CSP score was 0.941, and the discrimination value in the validation cohort was consistent (AUC = 0.813).ConclusionsThe CSP score represents a risk-predictive model for in-hospital mortality in patients with CS in acute care settings. Patients identified as the high-risk category may have a poor prognosis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The CSP (Cardiogenic Shock Prognosis) Score: A Tool for Risk Stratification of Cardiogenic Shock

Tien

Chen

Huang

et al. 2022

Front. Cardiovasc. Med.

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“…Respiratory complications were 24.2% in the urgent group versus 15,4% in the non-urgent group (p < 0.001) ( Table 2 ), probably due to higher incidence of circulatory failure observed in the urgent group recipients [25] , [26] , [27] . Patients in the urgent group were discharged to the rehab facility more than 2.5-fold more than the non-urgent group after a lengthier hospital stay (average of eight days versus two days in the non-urgent group) ( Table 2 ).…”

Section: Discussionmentioning

confidence: 99%

National outcomes of urgent vs. non-urgent percutaneous edge-to-edge transcatheter mitral valve repair

Al‐Khadra

Baibars

Dakkak

et al. 2022

IJC Heart & Vasculature

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“…For cardiogenic shock, the American Heart Association (AHA) consensus also reported that there is insufficient evidence to guide the pharmacological management judiciously, however it described all the pharmacological possibilities for hemodynamic return (van Diepen et al 2017). The association of dobutamine is normally used as a rescue alternative for cardiogenic shock in an attempt to improve cardiac contractility (Kim et al, 2020, Thiele et al, 2015.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of vasopressin use in the management of refractory shock in patients admitted to the intensive care unit

Macedo

Miyoshi

Baglie

et al. 2022

RSD

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Refractory shock is characterized by hemodynamic instability unresponsive to norepinephrine with a high mortality rate. As there are still doubts regarding the pharmacological benefit of the vasopressin addition, this retrospective study aimed to assess the profile of vasopressin use in the intensive care unit of a university hospital in Paraná, Brazil. The information collected was obtained through the analysis of electronic medical records. 73 patients with refractory shock, mainly of septic etiology (61.6%), were included. The dose (μg/Kg/minute) and duration of norepinephrine, upon finding refractoriness, was 35.6% infusion < 1, 34, 3% of 1-1.9, 30.1% > 2 and mean time of 1.5 days. High mortality (80.8%) was observed, with a mean hospital stay of 8.2 days. Median survival after vasopressin infusion was 4.5 days until the unfavorable outcome. Still, 80.5% of patients used other adjuvant therapy, 71.2% being corticotherapy and 9.6% dobutamine. Due to the great variability, it was not possible to define a pattern of use. There were limitations in the analysis due to the lack of clinical and prognostic information. However, the need for deepening scientific discussions and continuous updating of protocols that guide management is highlighted.

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Management of Cardiogenic Shock in a Cardiac Intensive Care Unit

Cited by 13 publications

References 42 publications

The CSP (Cardiogenic Shock Prognosis) Score: A Tool for Risk Stratification of Cardiogenic Shock

The CSP (Cardiogenic Shock Prognosis) Score: A Tool for Risk Stratification of Cardiogenic Shock

National outcomes of urgent vs. non-urgent percutaneous edge-to-edge transcatheter mitral valve repair

Evaluation of vasopressin use in the management of refractory shock in patients admitted to the intensive care unit

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