Age as a predictor of clinical outcomes and determinant of therapeutic measures for emergency medical services treated cardiogenic shock

Xiao, Xiaoman; Bloom, Jason; Andrew, Emily; Dawson, L.; Nehme, Ziad; Stephenson, Michael; Anderson, Damon Lindsay; Fernando, Himawan; Noaman, Samer; Cox, Sue; Chan, William; Kaye, D.; Smith, Karen

doi:10.26599/1671-5411.2023.01.004

Cited by 2 publications

(1 citation statement)

References 45 publications

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“…These protocols might include, among other variables, age. Age is a predictor of poor outcomes in CS patients [20], but should not be used as the only variable in the decision-making process. Data regarding the use of MCS in elderly patients with CS are scarce, but a benefit is suggested even in octogenarians [21].…”

Section: Discussionmentioning

confidence: 99%

Survey on Cardiogenic Shock and the Use of ECMO and Impella in Spanish Cardiac Critical Care Units

Martínez-Sellés,

García Carreño,

Martínez-Solano

et al. 2023

JVD

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Background: Previous studies suggest variability in the management of cardiogenic shock (CS). Methods: An anonymous survey was sent to Spanish hospitals. Results: We obtained 50 answers, mainly from cardiologists (36–72%). The annual average of ECMOs is 16.7 ± 11.3 applications in CS patients and of Impellas is 8.7 ± 8.3 applications in CS patients. Intra-aortic balloon counterpulsation is used in the majority of CS ECMOs (31–62%), and Impella is used in 7 (14%). In 36 (72%) cases, ECMO is used as a treatment for cardiac arrest. In 10 cases, ECMO removal is percutaneous (20%). In 25 (50%) cases, age is a relative contraindication; 17 have a mobile ECMO team (34%); and 23 (46%) have received ECMO patients from other centers in the last year. Pre-purged ECMO is only used in 16 (32%). ECMO implantation is carried out under ultrasound guidance in 31 (62%), only with angiography in 3 (6%) and with both in 11 (22%). The Swan–Ganz catheter is used routinely in 8 (16%), only in doubtful cases in 24 (48%), and in most cases in 8 (16%). The ECMO awake strategy is used little or not at all in 28 (56%), in selected cases in 17 (34%), and routinely in 5 (10%). Conclusion: Our study shows a huge variation in the management of patients with CS.

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Section: Discussionmentioning

confidence: 99%

Survey on Cardiogenic Shock and the Use of ECMO and Impella in Spanish Cardiac Critical Care Units

Martínez-Sellés,

García Carreño,

Martínez-Solano

et al. 2023

JVD

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Prehospital factors predicting mortality in patients with shock: state-wide linkage study

Eliakundu,

Bloom,

Ball

et al. 2024

Open Heart

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BackgroundPatients with shock treated by emergency medical services (EMS) have high morbidity and mortality. Knowledge of prehospital factors predicting outcomes in patients with shock remains limited. We aimed to describe the prehospital predictors of mortality in patients with non-traumatic shock transported to hospital by EMS.MethodThis is a retrospective cohort study of consecutive ambulance attendances for non-traumatic shock in Victoria, Australia (January 2015–June 2019) linked with government-held administrative data (emergency, admissions and mortality records). Predictors of 30-day mortality were assessed using Cox proportional regressions. The primary outcome was 30-day all-cause mortality.ResultsOverall, 21 334 patients with non-traumatic shock (median age 69 years, 54.8% female) were successfully linked with state administrative records. Among this cohort, 9 149 (43%) patients died within 30-days. Compared with survivors, non-survivors had a longer median on-scene time: 60 (35–98) versus 30 (19–50), p <0.001. Non-survivors were more likely to be older (median age in years: 74 (61–84) vs 65 (47–78), p<0.001), had prehospital cardiac arrest requiring cardiopulmonary resuscitation (adjusted HR (aHR)=6.26, 95% CI 5.87, 6.69) and had prehospital intubation (aHR=1.07, CI 1.00, 1.14). Reduced 30-day mortality was associated with administration of epinephrine (aHR=0.66, CI 0.62, 0.71) and systolic blood pressures above 80 mm Hg in the prehospital setting.ConclusionThe 30-day mortality from non-traumatic shock is high at 43%. Independent predictors of mortality included age, prehospital cardiac arrest and endotracheal intubation. Interventions that target reversible causes of short-term mortality in patients with non-traumatic shock are a high priority.

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Age as a predictor of clinical outcomes and determinant of therapeutic measures for emergency medical services treated cardiogenic shock

Cited by 2 publications

References 45 publications

Survey on Cardiogenic Shock and the Use of ECMO and Impella in Spanish Cardiac Critical Care Units

Survey on Cardiogenic Shock and the Use of ECMO and Impella in Spanish Cardiac Critical Care Units

Prehospital factors predicting mortality in patients with shock: state-wide linkage study

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