Design and preliminary results of FRENSHOCK 2016: A prospective nationwide multicentre registry on cardiogenic shock

Delmas, Clément; Puymirat, Étienne; Leurent, Guillaume; Elbaz, Meyer; Manzo-Silberman, Stéphane; Bonello, Laurent; Gerbaud, Édouard; Bataille, Vincent; Lévy, Bruno; Lamblin, Nicolas; Bonnefoy, Éric; Henry, Patrick; Roubille, François

doi:10.1016/j.acvd.2019.02.001

“…Cardiogenic shock was diagnosed using a combination of three criteria as defined in the FRENSHOCK registry [ 17 ]: low cardiac output (low cardiac index < 2.2 L/min/m 2 and/or systolic blood pressure < 90 mmHg or vasopressors/inotropes needed to maintain systolic blood pressure > 90 mmHg). right and/or left ventricular overload defined by congestive clinical features, natriuretic peptide elevation, radiological, echocardiographic, and/or hemodynamical parameters.…”

Section: Methodsmentioning

confidence: 99%

“…Cardiogenic shock was diagnosed using a combination of three criteria as defined in the FRENSHOCK registry [17]:…”

Section: Methodsmentioning

confidence: 99%

Successful Reversal of Severe Tachycardia-Induced Cardiomyopathy with Cardiogenic Shock by Urgent Rhythm or Rate Control: Only Rhythm and Rate Matter

Volle

¹

,

Delmas

²

,

Rollin

³

et al. 2021

JCM

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Background and objectives Severe forms of Tachycardia-induced cardiomyopathy (TIC) with cardiogenic shock are not well described so far, and efficiency of catheter ablation in this setting is unknown. Methods We retrospectively included consecutive patients admitted to the Intensive Cardiac Care Unit for acute heart failure with cardiogenic shock associated with atrial arrhythmia and managed by ablation. Result Fourteen patients were included, each with cardiogenic shock and two needing the use of extracorporeal membrane oxygenation. Successful ablation was performed in the acute setting or over the following weeks. Two patients experienced relapses of arrhythmias and were treated by new ablation procedures. At 7.5 ± 5 months follow-up, all patient were alive with stable sinus rhythm. The left ventricular Ejection Fraction dramatically improved (21 vs. 54%, p = 0.001) as well as the end-diastolic left ventricular diameter (61 vs. 51 mm, p = 0.01) and NYHA class (class IV in all vs. median 1, p = 0.002). Conclusion Restoration and maintenance of sinus rhythm in severe TIC with cardiogenic shock and atrial arrhythmias lead to a major increase or normalization of LVEF, reduction of ventricular dimensions, and improvement in functional status. Ablation is efficient in long-term maintenance of sinus rhythm and may be proposed early in refractory cases.

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“…In a multivariable analysis of the FRENCHSHOCK registry ( N = 772) of patients admitted to ITU with cardiogenic shock [ 20 ] (albeit nonischemic in 64%), independent predictors of 30-day mortality included age, low SBP, high arterial lactate, low eGFR, and low LVEF. These results broadly match our set of variables even though our data relates to patients presenting with ACS.…”

Section: Discussionmentioning

confidence: 99%

Rapid Classification and Treatment Algorithm of Cardiogenic Shock Complicating Acute Coronary Syndromes: The SAVE ACS Classification

Panoulas

¹

,

Ilsley

²

2022

Journal of Interventional Cardiology

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Introduction. We aimed to identify the independent “frontline” predictors of 30-day mortality in patients with acute coronary syndromes (ACS) and propose a rapid cardiogenic shock (CS) classification and management pathway. Materials and Methods. From 2011 to 2019, a total of 11439 incident ACS patients were treated in our institution. Forward conditional logistic regression analysis was performed to determine the “frontline” predictors of 30 day mortality. The C-statistic assessed the discriminatory power of the model. As a validation cohort, we used 431 incident ACS patients admitted from January 1, 2020, to July 20, 2020. Results. Independent predictors of 30-day mortality included age (OR 1.05; 95% CI 1.04 to 1.07, p < 0.001 ), intubation (OR 7.4; 95% CI 4.3 to 12.74, p < 0.001 ), LV systolic impairment (OR severe_vs_normal 1.98; 95% CI 1.14 to 3.42, p = 0.015 , OR moderate_vs_normal 1.84; 95% CI 1.09 to 3.1, p = 0.022 ), serum lactate (OR 1.25; 95% CI 1.12 to 1.41, p < 0.001 ), base excess (OR 1.1; 95% CI 1.04 to 1.07, p < 0.001 ), and systolic blood pressure (OR 0.99; 95% CI 0.982 to 0.999, p = 0.024 ). The model discrimination was excellent with an area under the curve (AUC) of 0.879 (0.851 to 0.908) ( p < 0.001 ). Based on these predictors, we created the SAVE (SBP, Arterial blood gas, and left Ventricular Ejection fraction) ACS classification, which showed good discrimination for 30-day AUC 0.814 (0.782 to 0.845) and long-term mortality p log − rank < 0.001 . A similar AUC was demonstrated in the validation cohort (AUC 0.815). Conclusions. In the current study, we introduce a rapid way of classifying CS using frontline parameters. The SAVE ACS classification could allow for future randomized studies to explore the benefit of mechanical circulatory support in different CS stages in ACS patients.

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“…However, no study has investigated which subjects would bene t most from this approach, when considering factors such as age, injury mechanism, setting, or the presence or absence of hypotension [26]. The in uence of these approaches on coagulation has not been su ciently examined, even in animal studies and the overall effectiveness of permissive hypotension/ hypotensive resuscitation is still inconclusive and mandates further research [10][11][12]21].…”

Section: Discussionmentioning

confidence: 99%

Pre-hospital Management in Trauma Patients: a Comparison Between Austria and Germany

Kanovsky

¹

,

Deininger

²

,

Wichlas

³

et al. 2021

Preprint

0

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ObjectivesTo compare the pre-hospital treatment and intervention regimen for major trauma patients with comparable injury patterns between Austria (AUT) and Germany (GER). Patients and MethodsThis analysis is based on data retrieved from the TraumaRegister DGU®. Data included severely injured trauma patients with an Injury Severity Score (ISS) ≥ 16, an age ≥ 16, and who were primary admitted to an Austrian (n=4.186) or German (n=41.670) Level I Trauma Center from 2008 to 2017. Endpoints included pre-hospital times and interventions performed until final hospital admission. The analyzed data include patients’ demographics, mode of transportation, pre-hospital time management, hemodynamic stability, and various pre-hospital interventions.ResultsThe cumulative time for transportation from the site of accident to the hospital did not significantly differ between the countries (62 min. in AUT, 65 min. in GER). Overall, 53% of all trauma patients in AUT were transported to the hospital with a helicopter compared to 37% in GER (P<0.001). The rate of intubation - 48% in both countries, the number of chest tubes placed (5.7% GER, 4.9% AUT), and the frequency of administered catecholamines (13.4% GER, 12.3% AUT) was comparable (Φ=0.00). Hemodynamic instability upon arrival in the TC was higher in AUT, (20.6% vs. 14.7% in GER; P<0.001). A median of 500mL of fluid was administered in AUT, whereas in GER 1000mL were infused (P<0.001). Patient demographics did not reveal a relationship (Φ=0.00) and the majority of patients sustained a blunt trauma (96%). ConclusionA significant higher number of Helicopter EMS transports (HEMS) were carried out in AUT. This can be explained by the overall lack of a unified transport algorithm. The authors suggest implementing an international guideline to explicitly use the HEMS system for trauma patients only a) for the rescue/care of people who have had an accident or are in life-threatening situations, b) for the transport of emergency patients with ISS>16, c) for transport of rescue personnel to hard-to-reach regions or, d) for the transport of medicinal products. Further, the amount of administered fluid in the pre-clinical setting should follow the concept of permissive hypotension/ hypotensive resuscitation, however the data are still inconclusive and mandate further research.

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Design and preliminary results of FRENSHOCK 2016: A prospective nationwide multicentre registry on cardiogenic shock

Cited by 40 publications

References 30 publications

Successful Reversal of Severe Tachycardia-Induced Cardiomyopathy with Cardiogenic Shock by Urgent Rhythm or Rate Control: Only Rhythm and Rate Matter

Successful Reversal of Severe Tachycardia-Induced Cardiomyopathy with Cardiogenic Shock by Urgent Rhythm or Rate Control: Only Rhythm and Rate Matter

Rapid Classification and Treatment Algorithm of Cardiogenic Shock Complicating Acute Coronary Syndromes: The SAVE ACS Classification

Pre-hospital Management in Trauma Patients: a Comparison Between Austria and Germany

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