Mechanical respiratory support in cardiogenic shock

Miller, Paul E.; Giménez, María Rubini; Thiele, Holger

doi:10.1002/ejhf.1599

Cited by 4 publications

(2 citation statements)

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“…One poorly researched aspect of patient care in CS is the management of respiratory support, despite the intimate cardiopulmonary relationship between positive pressure ventilation and ventricular function [ 33 , 34 ]. We, therefore, set out to investigate to what extent cDPP3 is associated with the need for mechanical ventilation and short-term outcomes in a CS patient population.…”

Section: Introductionmentioning

confidence: 99%

Dipeptidyl Amino-Peptidase 3 (DPP3) as an Early Marker of Severity in a Patient Population with Cardiogenic Shock

et al. 2023

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Dipeptidyl amino-peptidase 3 (DPP3) is an aminopeptidase that is released into circulation upon cell death. DPP3 is involved in the degradation of angiotensins, enkephalines, and endomorphines. It has been shown that circulating DPP3 (cDPP3) plasma concentration increases in cardiogenic shock (CS) patients and correlates with high mortality risk. Cardiogenic shock is a life-threatening syndrome associated with organ hypoperfusion. One of the common causes of CS is acute myocardial infarction (AMI). This study aimed to investigate if cDPP3 levels are associated with CS severity and the need for ventilation in patients suffering from CS. Fifteen patients with CS were included in this study. Six patients were invasively ventilated. The values of cDPP3 were higher in ventilated patients than in non-ventilated patients at admission, 3 h, and 24 h after admission in the intensive care unit. Patients with pulmonary hypertension at admission also showed high cDPP3 values at all time points. Furthermore, high cDPP3 levels were associated with reduced stroke volume. Our results suggest that cDPP3 could predict CS progression and guide therapy escalation.

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Section: Introductionmentioning

confidence: 99%

Dipeptidyl Amino-Peptidase 3 (DPP3) as an Early Marker of Severity in a Patient Population with Cardiogenic Shock

et al. 2023

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“…As such, the effects of MV in improving hemodynamics by unloading the left ventricle, improving oxygenation and tissue perfusion, may play a beneficial role in CS, particularly when initiated early in the clinical course. However, despite the significant interactions with the cardiovascular system and pervasiveness in CS, the ideal management of respiratory failure, understanding of the risk factors, and the development of associated clinical outcomes or complications have to date not been adequately investigated [9,10]. Given the paucity of available data, we sought to explore the association between MV timing and strategy among patients with CS from the CULPRIT-SHOCK (Culprit Lesion Only PCI versus Multivessel PCI in Cardiogenic Shock) randomized clinical trial.…”

Section: Introductionmentioning

confidence: 99%

Outcomes associated with respiratory failure for patients with cardiogenic shock and acute myocardial infarction: a substudy of the culprit-shock trial

Giménez

Millet

Alviar

et al. 2020

European Heart Journal

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Background Respiratory insufficiency with the need for mechanical ventilation (MV) is one of the most common indications for admission to intensive care units. However, little is known about the clinical outcomes of patients with acute myocardial infraction (AMI) complicated by cardiogenic shock (CS) who require mechanical ventilation (MV). The aim of this study was to identify the characteristics, risk factors, and outcomes associated with the provision of MV in this specific high-risk population. Methods Patients with CS complicating AMI and multivessel coronary artery disease from the CULPRIT-SHOCK trial were included. We explored clinical outcome within 30 days in patients not requiring MV, those with MV on admission, and those in whom MV was initiated within the first day after admission. Results Among 683 randomized patients included in the analysis, 17.4% received no MV, 59.7% were ventilated at admission and 22.8% received MV within or after the first day after admission. Patients requiring MV were younger, more frequently non-smokers, had higher body mass indices, presented more often with clinical signs of impaired organ perfusion including worse renal function, higher burden of coronary artery disease, were more likely to have experienced resuscitation within 24h before admission, had worse left ventricular function, and presented more often with non-ST-segment elevation myocardial infarction. The primary endpoint of all-cause death or need for renal replacement therapy occurred in 21.8% of patients without MV, in 53.3% of patients with MV at admission (adjusted odds ratio [aOR] 6.03, 95% confidence interval (CI) 3.17–11.47, p=0.002, compared to patients without) and 65.4% of patients with MV initiated within the first day after admission (aOR 8.09 95% CI 4.32–15.16, p<0.001, compared to patients without). Factors independently associated with the provision of MV on admission included higher body weight, resuscitation within 24h before admission, elevated heart rate and evidence of triple vessel disease. Conclusions Requiring MV in patients with CS complicating AMI is common and independently associated with mortality after adjusting for covariates. Patients with delayed MV initiation appear to be at higher risk of adverse outcomes. Further research is necessary to identify the optimal timing of MV in this high-risk population. Funding Acknowledgement Type of funding source: Public grant(s) – EU funding. Main funding source(s): Swiss National Foundation

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Prognostic Influence of Lung Compliance in Patients with Cardiogenic Shock and Invasive Mechanical Ventilation

Rusnak,

Schupp,

Weidner

et al. 2024

Rev. Cardiovasc. Med.

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Background: There is limited data regarding the influence of lung compliance on the outcome of patients with cardiogenic shock (CS). Thus, a registry study was conducted to assess the prognostic influence of lung compliance in invasively ventilated patients with CS. Methods: Hospital records for consecutive invasively ventilated CS-patients from June 2019 to May 2021 were collected into a prospective registry. Our study evaluated the prognostic influence of lung compliance on 30-day all-cause mortality. Statistical analyses comprised t-tests, analysis of variance (ANOVA), Kruskal-Wallis-tests, Spearman’s correlation, Kaplan-Meier survival analyses, and Cox regression. Results: A total of 141 patients with CS requiring invasive mechanical ventilation were included. Stratification by quartiles revealed that patients with the lowest lung compliance (≤23.8 mL/cmH2O) experienced the highest mortality rates (77.1% vs. 66.7% vs. 48.6% vs. 51.4%; log-rank p = 0.018) both overall and among the subgroup of CS-patients with cardiac arrest (80% vs. 74% vs. 53% vs. 59%; log-rank p = 0.037). After stratifying by the median, patients with lung compliance <30.4 mL/cmH2O demonstrated a significantly higher 30-day all-cause mortality compared to those above this threshold (71.8% vs. 50.0%; log-rank p = 0.007) for both the overall cohort and the cardiac arrest subgroup (77.2% vs. 55.9%; log-rank p = 0.008). Multivariable adjustment confirmed that lung compliance <30.4 mL/cmH2O was significantly associated with increased 30-day all-cause mortality in the entire cohort (hazard ratio [HR] = 1.698; 95% CI 1.085–2.659; p = 0.021). Notably, this association was not significant in CS-patients with cardiac arrest (HR = 1.523; 95% CI 0.952–2.438; p = 0.080). Additionally, those with lung compliance below the median experienced fewer ventilator-free days (p = 0.003). Conclusions: In invasively ventilated CS-patients, low lung compliance was associated with higher all-cause mortality and fewer ventilator-free days at 30 days. Clinical Trial Registration: NCT05575856, https://clinicaltrials.gov/study/NCT05575856.

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Mechanical respiratory support in cardiogenic shock

Cited by 4 publications

References 5 publications

Dipeptidyl Amino-Peptidase 3 (DPP3) as an Early Marker of Severity in a Patient Population with Cardiogenic Shock

Dipeptidyl Amino-Peptidase 3 (DPP3) as an Early Marker of Severity in a Patient Population with Cardiogenic Shock

Outcomes associated with respiratory failure for patients with cardiogenic shock and acute myocardial infarction: a substudy of the culprit-shock trial

Prognostic Influence of Lung Compliance in Patients with Cardiogenic Shock and Invasive Mechanical Ventilation

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