Clinical Management of Cardiogenic Shock and Cardiac Arrest

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: 25 August 2024 | Viewed by 3894

Special Issue Editor


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Guest Editor
Baylor Scott and White Health, Temple, TX, USA
Interests: cardiogenic shock; heart replacement; heart recovery; transitions in mechanical circulatory support

Special Issue Information

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

Published Papers (4 papers)

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Research

11 pages, 950 KiB  
Article
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 - 08 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 [...] Read more.
(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  
Article
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
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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) [...] Read more.
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  
Article
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 - 07 Sep 2023
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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. [...] Read more.
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  
Article
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 Registrationadd Show full author list remove Hide full author list
J. Clin. Med. 2023, 12(16), 5221; https://doi.org/10.3390/jcm12165221 - 10 Aug 2023
Cited by 2 | Viewed by 978
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 [...] Read more.
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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