Pulmonary Artery Catheter Use and Mortality in the Cardiac Intensive Care Unit

Kadosh, Bernard; Berg, David D.; Bohula, Erin A.; Park, Jeong‐Gun; Baird-Zars, Vivian M; Alviar, Carlos L.; Alzate, James; Barnett, Christopher F.; Barsness, Gregory W.; Burke, James A.; Chaudhry, Sunit‐Preet; Daniels, Lori B.; DeFilippis, Andrew P.; Delicce, Anthony; Fordyce, Christopher B.; Ghafghazi, Shahab; Gidwani, Umesh; Goldfarb, Michael; Katz, Jason N.; Keeley, Ellen C.; Kenigsberg, Benjamin; Kontos, Michael C.; Lawler, Patrick R.; Leibner, Evan; Menon, Venu; Metkus, Thomas S.; Miller, Paul E.; Papolos, Alexander; Prasad, Rajnish; Shah, Kevin; Sinha, Shashank S.; Snell, R. Jeffrey; So, Derek; Solomon, Michael A.; Ternus, Bradley; Teuteberg, Jeffrey J.; Toole, Joseph; Diepen, Sean van; Morrow, David A.; Roswell, Robert O.

doi:10.1016/j.jchf.2023.04.007

Cited by 34 publications

(23 citation statements)

References 28 publications

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“…However, the prognosis for CS varies widely by the stage. [5][6][7] In SCAI stage A and B, in-hospital mortality is reported to be less than 10%, while in SCAI stage D it is around 40% and in SCAI stage E around 70%. 7 Therefore, if the patient is in SCAI stage E, the risk is high and a TEER is not likely to be performed.…”

Section: Discussionmentioning

confidence: 99%

“…4 However, the use of TEER in patients with cardiogenic shock (CS) and MR is not well studied, as these patients were excluded from RCTs. CS still carries a high mortality rate and its management is challenging, [5][6][7] whereas the presence of MR in CS patients is known to be associated with poor prognosis. 8,9 In patients with CS, MR can be either degenerative or functional as well as acute or chronic.…”

Section: Introductionmentioning

confidence: 99%

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Transcatheter edge‐to‐edge mitral valve repair for mitral regurgitation in patients with cardiogenic shock: A systematic review and meta‐analysis

Saito,

Kuno,

Ueyama

et al. 2023

Cathet Cardio Intervent

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BackgroundThere is currently little evidence for transcatheter edge‐to‐edge mitral valve repair (TEER) for mitral regurgitation (MR) in patients with cardiogenic shock (CS). Therefore, this study investigated the characteristics and outcomes of CS patients who underwent TEER for MR.MethodsPubMed, EMBASE were searched in July 2023. Case series and observational studies reporting clinical characteristics and outcomes in CS patients with MR who underwent TEER were included. We performed a one‐group meta‐analysis using a random effects model.ResultsA total of 4060 patients from 7 case series and 5 observational studies were included. The mean age was 68.2 (95% confidence interval [CI]: 64.1–72.2) years, and 41.4% of patients (95% CI: 39.1%–43.7%) were female. Pre‐TEER, severe MR was present in 85.3% (95% CI: 76.1%–91.3%) of patients. Mean left ventricular ejection fraction was 36.7% (95% CI: 29.2%–44.2%), and 54.6% (95% CI: 36.9%–71.2%) of patients received mechanical circulatory support. The severity of MR post‐TEER was less than 2+ in 88% (95% CI: 87%–89%) of patients. In‐hospital mortality was 11% (95% CI: 10%–13%), whereas 30‐day and 1‐year mortality rates were 15% (95% CI: 13%–16%), and 36% (95% CI: 21%–54%), respectively.ConclusionsThis systematic review and meta‐analysis assessed the clinical characteristics and outcomes of TEER in CS patients with MR. TEER for MR in patients with CS has been successful in reducing MR in most of the patients, but with a high mortality rate. Randomized controlled trials of TEER for MR and CS are needed.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Transcatheter edge‐to‐edge mitral valve repair for mitral regurgitation in patients with cardiogenic shock: A systematic review and meta‐analysis

Saito,

Kuno,

Ueyama

et al. 2023

Cathet Cardio Intervent

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“…157,158 The use of PAC has recently been associated with improved survival in patients with CS and its increased use may be warranted until evidence will come from proper prospective randomized trials. [159][160][161] After the 'rescue phase', the goal is to tailor the pharmacological support to the haemodynamic status until reaching a phase of stability ('optimization phase'). 156 A MAP >65 mmHg may be considered a reasonable target for treatment.…”

Section: Escalation and De-escalation: The Importance Of A Multistep ...mentioning

confidence: 99%

“…168 use of PAC may allow better indication for the escalation and de-escalation strategies and, accordingly, it has recently been associated with improved survival in patients with CS. [159][160][161]168,170 .…”

Section: Escalation and De-escalation: The Importance Of A Multistep ...mentioning

confidence: 99%

Medical therapy of cardiogenic shock: Contemporary use of inotropes and vasopressors

Riccardi,

Pagnesi,

Chioncel

et al. 2024

European J of Heart Fail

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Cardiogenic shock is a primary cardiac disorder that results in both clinical and biochemical evidence of tissue hypoperfusion and can lead to multi‐organ failure and death depending on its severity. Inadequate cardiac contractility or cardiac power secondary to acute myocardial infarction remains the most frequent cause of cardiogenic shock, although its contribution has declined over the past two decades, compared with other causes. Despite some advances in cardiogenic shock management, this clinical syndrome is still burdened by an extremely high mortality. Its management is based on immediate stabilization of haemodynamic parameters so that further treatment, including mechanical circulatory support and transfer to specialized tertiary care centres, can be accomplished. With these aims, medical therapy, consisting mainly of inotropic drugs and vasopressors, still has a major role. The purpose of this article is to review current evidence on the use of these medications in patients with cardiogenic shock and discuss specific clinical settings with indications to their use.

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“…Based on the recent CSWG observational data, 90% of the patients with SCAI B deteriorated to a higher SCAI stage (i.e., C/D/E) during the course of their index hospitalization; the mean time to achieving the maximum SCAI stage was 52 h ( 36 ). Hence, early institution of PA catheter guided hemodynamic management may be useful in identifying worsening HF-CS patients sooner and potentially lead to improved outcomes ( 87 , 88 ). Patients with worsening hypotension and hypoperfusion with elevated lactate levels and evidence of end-organ dysfunction should be transferred to dedicated AHA Level 1 cardiac ICUs with invasive hemodynamic monitoring to reduce the risk of progression to hemometabolic HF-CS.…”

Section: Introductionmentioning

confidence: 99%

Contemporary approach to cardiogenic shock care: a state-of-the-art review

Mehta,

Vavilin,

Nguyen

et al. 2024

Front. Cardiovasc. Med.

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Cardiogenic shock (CS) is a time-sensitive and hemodynamically complex syndrome with a broad spectrum of etiologies and clinical presentations. Despite contemporary therapies, CS continues to maintain high morbidity and mortality ranging from 35 to 50%. More recently, burgeoning observational research in this field aimed at enhancing the early recognition and characterization of the shock state through standardized team-based protocols, comprehensive hemodynamic profiling, and tailored and selective utilization of temporary mechanical circulatory support devices has been associated with improved outcomes. In this narrative review, we discuss the pathophysiology of CS, novel phenotypes, evolving definitions and staging systems, currently available pharmacologic and device-based therapies, standardized, team-based management protocols, and regionalized systems-of-care aimed at improving shock outcomes. We also explore opportunities for fertile investigation through randomized and non-randomized studies to address the prevailing knowledge gaps that will be critical to improving long-term outcomes.

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Pulmonary Artery Catheter Use and Mortality in the Cardiac Intensive Care Unit

Cited by 34 publications

References 28 publications

Transcatheter edge‐to‐edge mitral valve repair for mitral regurgitation in patients with cardiogenic shock: A systematic review and meta‐analysis

Transcatheter edge‐to‐edge mitral valve repair for mitral regurgitation in patients with cardiogenic shock: A systematic review and meta‐analysis

Medical therapy of cardiogenic shock: Contemporary use of inotropes and vasopressors

Contemporary approach to cardiogenic shock care: a state-of-the-art review

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