Application of pulse index continuous cardiac output system in elderly patients with acute myocardial infarction complicated by cardiogenic shock: A prospective randomized study

Abstract

BACKGROUND Cardiogenic shock (CS) secondary to acute myocardial infarction (AMI) complicates management of the condition, and often leads to poor prognosis. Prompt and accurate monitoring of cardiovascular and accompanying hemodynamic changes is crucial in achieving adequate management of the condition. Advances in technology has availed procedures such as pulse index continuous cardiac output (PiCCO), which can offer precise monitoring of cardiovascular functions and hemodynamic parameters. In this study, PiCCO is evaluated for its potential utility in improving management and clinical outcomes among elderly patients with AMI complicated by CS. AIM To assess whether use of the PiCCO system can improve clinical outcomes in elderly patients with AMI complicated by CS. METHODS Patients from emergency intensive care units (EICU) or coronary care units (CCU) were randomized to receive PiCCO monitoring or not. The APACHE II score, SOFA score, hs-TnI, NT-proBNP, PaO 2 /FiO 2 ratio and lactate levels on day 1, 3 and 7 after treatment were compared. The infusion and urine volume at 0-24 h, 24-48 h and 48-72 h were recorded, as were the cardiac index (CI), extravascular lung water index (EVLWI), intrathoracic blood volume index (ITBVI) and global end diastolic volume index (GEDVI) at similar time intervals. RESULTS Sixty patients with AMI complicated by CS were included in the study. The PiCCO group had a significantly lower APACHE II score, SOFA score, hs-TnI and NT-proBNP levels on day 1, 3 and 7 after treatment. The infusion and urine volume during 0-24 h in the PiCCO group were significantly greater, and this group also showed significantly higher ADL scores. Furthermore, the PiCCO group spent lesser days on vasoactive agents, mechanical ventilation, and had a reduced length of stay in EICU/CCU. Additionally, the CI was significantly higher at 48 h and 72 h in the PiCCO group compared with that at 24 h, and the EVLWI, ITBVI and GEDVI were significantly decreased at 48 h and 72 h. CONCLUSION Applying the PiCCO system could improve the clinical outcomes of elderly patients with AMI complicated by CS.

Safety and efficacy of pulse-induced contour cardiac output monitoring in elderly patients with coronary artery disease and severe heart failure at coronary care units

“…This clinical study is the first real-world prospective observational study to investigate the safety and efficacy of early PiCCO monitoring in elderly patients with coronary heart disease and severe heart failure. The results showed that invasive PiCCO monitoring reduced the risk of hospital/CCU stay without increasing the incidence of 1-month mortality, which is consistent with other reports ( 11 , 12 ). PiCCO indicators reflect cardiac function in order to precisely and accurately diagnose, treat, and prevent.…”

An interaction effect analysis of thermodilution-guided hemodynamic optimization, patient condition, and mortality among successful cardiopulmonary resuscitation patients

“…31,32 The PiCCO™-guided hemodynamic management shortened the duration of vasoactive therapy, mechanical ventilation and ICU stay among elderly patients with cardiogenic shock after acute myocardial infarction. 33 However, there is a lack of evidence regarding the effect of PiCCO™ monitoring system and PiCCO™ guided therapy on mortality in post-cardiac arrest treatment -and this is why our study ndings are unique and much needed.…”

Hemodynamic Monitoring by Smartphone—Preliminary Report from a Comparative Prospective Observational Study

“…Identification of patients who will not benefit from fluid therapy avoids harmful fluid overload, and after hemodynamic stabilization it enables the controlled correction of the cumulative positive balance with the use of diuretics and continuous renal replacement therapies [21]. Contrary to thermodilution, the CS application, based on the APCO method, does not provide several useful parameters, such as the extravascular lung water index (EVLWI), the intrathoracic blood volume index (ITBVI), and the global end-diastolic volume index (GEDVI) [22]. However, in the absence of thermodilution methods, repeated SV and/or PPV assessment in the CS application during the fluid challenge or passive test raising (PLR) may be a valuable supplement to the assessment of fluid susceptibility [23].…”