Clinical Characteristics and Current Interventions in Shock Patients in Chinese Emergency Departments

Abstract

Background:Shock is a life-threatening condition in emergency departments (EDs) and is associated with a high mortality; however, its clinical characteristics and current interventions in China are seldom reported. This study investigated the clinical characteristics and current interventions of shock patients in Chinese EDs.Methods:This multicenter prospective cohort study was conducted in the EDs of 33 academic hospitals in 16 Chinese provinces. Adult shock patients were enrolled from December 2013 to April 2014. Age, sex, comorbidities, shock subtype, and vital signs were recorded on ED arrival; details of subsequent interventions and treatments were added. We compared those data between survivors and nonsurvivors. All patients were followed up for 3 days. The primary outcome was 3-day mortality. Binary logistic regression analysis identified the independent predictors of that mortality.Results:We enrolled 1095 shock patients. The 3-day mortality was 27.5%, 36.3%, and 29.0%, respectively, in the whole cohort and for cardiogenic and septic shock. Within the first 24 h, 1039 patients (94.9%) were admitted to the Intensive Care Unit. Use of bicarbonate, epinephrine, and dopamine is an independent predictor for mortality. Hemorrhage and trauma (39.1%), along with sepsis (40.4%) were the most commonly observed causes of shock in the ED. In nondiabetic patients with cardiogenic shock, 3-day mortality was 69.2% for patients needing glucose control — much higher than in those not needing glucose control (30.0%, P = 0.01). Hydroxyethyl starch (HES) was applied in 29.6% of septic shock patients, and the mortality of septic patients who received HES was much higher than those who did not (38.2% vs. 25.1%, P = 0.006).Conclusions:In China, short-term mortality of shock patients in EDs is still high, especially among those with cardiogenic and septic shock. HES application needs to be restricted — particularly in septic shock patients.

The medical treatment of cardiogenic shock: cardiovascular drugs

“…Aggregating data reported in 14 published cohorts and two unpublished data-sets, Leopold et al [21] reported that epinephrine use was associated with an increased risk of death in patients with cardiogenic shock. In a cohort of 168 patients with cardiogenic shock, norepinephrine was associated with a lower risk of death compared to patients receiving epinephrine or dopamine [22].…”

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

“…36 Epinephrine results in an increased likelihood of death even in observational studies. 56,59,62 Therefore, epinephrine is not recommended as a first-line agent for CS. 2 This drug still has a pivotal role in cardiac arrest, being associated with a significantly higher rate of 30-day survival versus placebo among patients with out-of-hospital cardiac arrest enrolled in the PARAMEDIC2 (Prehospital Assessment of the Role of Adrenaline: Measuring the Effectiveness of Drug Administration in Cardiac Arrest) trial, although severe neurologic impairment at hospital discharge was more frequent in the epinephrine group in such trial.…”

“…An important contribution to the clinical use of epinephrine in CS comes from the already mentioned OptimaCC trial, where epinephrine was associated with a higher incidence of refractory shock as compared to norepinephrine 36 . Epinephrine results in an increased likelihood of death even in observational studies 56,59,62 . Therefore, epinephrine is not recommended as a first‐line agent for CS 2 .…”

How Shock Index Helps the Assessment of Hypovolemic Shock : A Scoping Review

“…Shock is a life-threatening condition that can result in death (Guo et al, 2017) . There are various cases of shock that occur in both trauma and non-traumatic cases, including hypovolemic shock, cardiogenic shock, obstructive shock and distributive shock (Standl et al, 2018).…”