Shock Team Approach in Refractory Cardiogenic Shock Requiring Short-Term Mechanical Circulatory Support

Taleb, Iosif; Koliopoulou, Antigone; Tandar, Anwar; McKellar, Stephen H.; Tonna, Joseph E.; Nativi-Nicolau, José; Villela, Miguel Alvarez; Welt, Frederick G.P.; Stehlik, Josef; Gilbert, Edward M.; Wever‐Pinzon, Omar; Morshedzadeh, Jack H.; Dranow, Elizabeth; Selzman, Craig H.; Fang, James C.; Drakos, Stavros G.

doi:10.1161/circulationaha.119.040654

Cited by 144 publications

(113 citation statements)

References 5 publications

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“…Additionally, the utilization of "CS teams" seems to be promising to improve outcomes in non-ischemic CS. Not only is CS a complex disease impacting multiple organs, for which CS teams might foster interdisciplinary care; CS teams could also develop dedicated diagnostic and treatment algorithms, tailored specifically to the underlying etiology [14,15].…”

Section: Differences In Patient Characteristics Between Non-ischemic mentioning

confidence: 99%

Patient Characteristics, Treatment and Outcome in Non-Ischemic vs. Ischemic Cardiogenic Shock

Schrage

Weimann

Dabboura

et al. 2020

JCM

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Aim: Evidence on non-ischemic cardiogenic shock (CS) is scarce. The aim of this study was to investigate differences in patient characteristics, use of treatments and outcomes in patients with non-ischemic vs. ischemic CS. Methods: Patients with CS admitted between October 2009 and October 2017 were identified and stratified as non-ischemic/ischemic CS based on the absence/presence of acute myocardial infarction. Logistic/Cox regression models were fitted to investigate the association between non-ischemic CS and patient characteristics, use of treatments and 30-day in-hospital mortality. Results: A total of 978 patients were enrolled in this study; median age was 70 (interquartile range 58, 79) years and 70% were male. Of these, 505 patients (52%) had non-ischemic CS. Patients with non-ischemic CS were more likely to be younger and female; were less likely to be active smokers, to have diabetes or decreased renal function, but more likely to have a history of myocardial infarction; and they were more likely to present with unfavorable hemodynamics and with mechanical ventilation. Regarding treatments, patients with non-ischemic CS were more likely to be treated with catecholamines, but less likely to be treated with extracorporeal membrane oxygenation or percutaneous left-ventricular assist devices. After adjustment for multiple relevant confounders, non-ischemic CS was associated with a significant increase in the risk of 30-day in-hospital mortality (hazard ratio 1.14, 95% confidence interval 1.04-1.24, p < 0.01). Conclusion: In this large study, non-ischemic CS accounted for more than 50% of all CS cases. Non-ischemic CS was not only associated with relevant differences in patient characteristics and use of treatments, but also with a worse prognosis. These findings highlight the need for effective treatment strategies for patients with non-ischemic CS.

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Section: Differences In Patient Characteristics Between Non-ischemic mentioning

confidence: 99%

Patient Characteristics, Treatment and Outcome in Non-Ischemic vs. Ischemic Cardiogenic Shock

Schrage

Weimann

Dabboura

et al. 2020

JCM

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“…The results from these two studies indicate that the SCAI classification provides adequate risk estimates in such broad CS populations. Barring a successful validation in a prospective trial, potentially including a comparison versus other CS scores, this classification could therefore be used to facilitate intra-disciplinary communication in the CS team and to improve awareness and early diagnosis of CS irrespective of the underlying cause 15,16. 4.1 | LimitationsThe major limitation of this study is its retrospective design.…”

mentioning

confidence: 99%

Application of the SCAI classification in a cohort of patients with cardiogenic shock

Schrage¹,

Dabboura²,

Yan³

et al. 2020

Cathet Cardio Intervent

144

134

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Background The Society of Cardiovascular Angiography and Interventions (SCAI) have recently proposed a new classification of cardiogenic shock (CS) dividing patients into five subgroups. Objective Aim of this study was to apply the SCAI classification to a cohort of patients presenting with CS and to evaluate its ability to predict 30‐day survival. Methods SCAI CS subgroups were interpreted based on the recent consensus statement and then applied to N = 1,007 consecutive patients presenting with CS or large myocardial infarction (MI) between October 2009 and October 2017. The association between SCAI classification and 30‐day all‐cause mortality was assessed by logistic regression analysis. Results Mean age in the study cohort was 67 (±15) years, 72% were male. Mean lactate at baseline was 6.05 (±5.13) mmol/l and 51% of the patients had prior cardiac arrest. Overall survival probability was 50.6% (95% confidence interval [CI] 47.5–54.0%). In view of the SCAI classification, the survival probability was 96.4% (95% CI 93.7–99.0%) in class A, 66.1% (95% CI 50.2–87.1%) in class B, 46.1% (95% CI 40.6–52.4%) in class C, 33.1% (95% CI 26.6–41.1%) in class D, and 22.6% (95% CI 17.1–30.0%) in class E. Higher SCAI classification was significantly associated with lower 30‐day survival (p < .01). Conclusion In this large clinical cohort, the SCAI classification was significantly associated with 30‐day survival. This finding supports the rationale of the SCAI CS classification and calls for a validation in a prospective trial.

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“…7 Recent work from two centers suggests that improvements in outcomes could be achieved using the current devices with multidisciplinary collaboration and a formal "shock team" approach. 8,9 One issue, however, which had not been addressed was the lack of a way to classify the various grades of CS in a standardized fashion.…”

mentioning

confidence: 99%

Prospective validation of the SCAI shock classification: Single center analysis

Baran

Long

Badiye

et al. 2020

Cathet Cardio Intervent

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Background: The Society for Cardiac Angiography and Interventions (SCAI) Shock Classification has been retrospectively validated by several groups. We sought to prospectively study outcomes of consecutive patients with reference to initial SCAI Shock Stage and therapeutic strategy as well as 24 hr SCAI Shock Stage reassessment. Methods: Kaplan Meier method was used to describe survival and Cox Proportional hazards modeling used to assess predictors of survival. Results: Over an 18-month period, 166 patients were referred for evaluation. Demographics, hemodynamics, and most laboratory findings were similar between SCAI stages, which were assigned by the team. Initial SCAI Stage was a strong predictor of survival. Thirty-day survival was 100, 65.4, 44.2, and 60% for patients with initial SCAI shock stage B, C, D, and E respectively (p = .0004). Age and initial SCAI Shock Stage were shown to be the strongest predictors of survival by Cox proportional hazards. Mode of mechanical circulatory support (MCS) or lack of such was not a predictor of outcome. Shock stage at 24 hr was also examined. Thirty-day survival was 100, 96.7, 66.9, 21.6, and 6.2% for patients with 3-4 SCAI stage improvement, 2 stage improvement, 1 stage improvement, no change in SCAI stage and worsening of SCAI stage respectively (p < .0001). Conclusions: Initial SCAI Shock stage predicts the survival of unselected patients with a variety of MCS interventions and medical therapy alone. The 24-hr reassessment of shock stage further refines the prognosis.

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Shock Team Approach in Refractory Cardiogenic Shock Requiring Short-Term Mechanical Circulatory Support

Cited by 144 publications

References 5 publications

Patient Characteristics, Treatment and Outcome in Non-Ischemic vs. Ischemic Cardiogenic Shock

Patient Characteristics, Treatment and Outcome in Non-Ischemic vs. Ischemic Cardiogenic Shock

Application of the SCAI classification in a cohort of patients with cardiogenic shock

Prospective validation of the SCAI shock classification: Single center analysis

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