Improved Outcomes Associated with the use of Shock Protocols: Updates from the National Cardiogenic Shock Initiative

被引：353

作者：

Basir, Mir B. ^{[1
]}

Kapur, Navin K. ^{[2
]}

Patel, Kirit ^{[3
]}

Salam, Murad A. ^{[3
]}

Schreiber, Theodore ^{[4
]}

Kaki, Amir ^{[4
]}

Hanson, Ivan ^{[5
]}

Almany, Steve ^{[5
]}

Timmis, Steve ^{[5
]}

Dixon, Simon ^{[5
]}

Kolski, Brian ^{[6
]}

Todd, Josh ^{[7
]}

Senter, Shaun ^{[8
]}

Marso, Steven ^{[9
]}

Lasorda, David ^{[10
]}

Wilkins, Charles ^{[11
]}

Lalonde, Thomas ^{[4
]}

Attallah, Antonious ^{[4
]}

Larkin, Timothy

Dupont, Allison ^{[12
]}

Marshall, Jeffrey ^{[12
]}

Patel, Nainesh ^{[13
]}

Overly, Tjuan ^{[14
]}

Green, Michael ^{[15
]}

Tehrani, Behnam ^{[16
]}

Truesdell, Alexander G. ^{[16
]}

Sharma, Rahul ^{[17
]}

Akhtar, Yasir ^{[18
]}

McRae, Thomas ^{[19
]}

O'Neill, Brian ^{[20
]}

Finley, John ^{[21
]}

Rahman, Ayaz ^{[22
]}

Foster, Malcolm ^{[23
]}

Askari, Raza ^{[24
]}

Goldsweig, Andrew ^{[25
]}

Martin, Scott ^{[26
]}

Bharadwaj, Aditya ^{[27
]}

Khuddus, Matheen ^{[28
]}

Caputo, Christopher ^{[28
]}

Korpas, Denes ^{[29
]}

Cawich, Ian ^{[30
]}

McAllister, David ^{[31
]}

Blank, Nimrod ^{[32
]}

Alraies, M. Chadi ^{[32
]}

Fisher, Ruth ^{[1
]}

Khandelwal, Akshay ^{[1
]}

Alaswad, Khaldoon ^{[1
]}

Lemor, Alejandro ^{[1
]}

Johnson, Tyrell ^{[1
]}

Hacala, Michael ^{[1
]}

机构：

[1] Henry Ford Hlth Syst, Dept Cardiol, Detroit, MI 48202 USA

[2] Tufts Med Ctr, Dept Cardiol, Boston, MA 02111 USA

[3] St Joseph Mercy Oakland, Dept Cardiol, Pontiac, MI USA

[4] Ascens St John Hosp, Dept Cardiol, Detroit, MI USA

[5] Beaumont Hosp, Dept Cardiol, Royal Oak, MI USA

[6] St Joseph Hosp, Dept Cardiol, Orange, CA USA

[7] Ft Sanders Reg Med Ctr, Dept Cardiol, Knoxville, TN USA

[8] Washington Reg Med Ctr, Dept Cardiol, Fayetteville, AR USA

[9] Overland Pk Reg Med Ctr & Res Med Ctr, Dept Cardiol, Overland Pk, KS USA

[10] Allegheny Gen Hosp, Dept Cardiol, Pittsburgh, PA 15212 USA

[11] San Juan Reg Med Ctr, Dept Cardiol, San Juan, PR USA

[12] Northeast Georgia Med Ctr, Dept Cardiol, Gainesville, FL USA

[13] Lehigh Valley Hosp, Dept Cardiol, Allentown, PA USA

[14] Univ Tennessee, Dept Cardiol, Med Ctr, Knoxville, TN 37996 USA

[15] Northwest Med Ctr Springdale, Dept Cardiol, Springdale, UT USA

[16] INOVA Heart & Vasc Inst, Dept Cardiol, Annandale, VA USA

[17] Caril Roanoke Mem Hosp, Dept Cardiol, Roanoke, VI USA

[18] Phys Reg Med Ctr, Dept Cardiol, Knoxville, TN USA

[19] Tristar Centennial Med Ctr, Dept Cardiol, Nashville, TN USA

[20] Temple Univ Hosp & Med Sch, Dept Cardiol, Philadelphia, PA 19140 USA

[21] Mercy Fitzgerald Hosp, Dept Cardiol, Yeadon, PA USA

[22] Parkwest Med Ctr, Dept Cardiol, Knoxville, TN USA

[23] Turkey Creek Med Ctr, Dept Cardiol, Knoxville, TN USA

[24] Methodist Univ Hosp, Dept Cardiol, Memphis, TN USA

[25] Univ Nebraska, Dept Cardiol, Lincoln, NE 68583 USA

[26] Stamford Hosp, Dept Cardiol, Stamford, CT USA

[27] Loma Linda Univ, Dept Cardiol, Med Ctr, Loma Linda, CA USA

[28] North Florida Reg Med Ctr, Dept Cardiol, Gainesville, FL USA

[29] CHI Hlth Nebraska Heart, Dept Cardiol, Lincoln, NE USA

[30] Arkansas Heart Hosp, Dept Cardiol, Little Rock, AR USA

[31] Mercy Med Ctr, Dept Cardiol, Rockville, MD USA

[32] Detroit Med Ctr, Dept Cardiol, Detroit, MI USA

来源：

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS | 2019年 / 93卷 / 07期

关键词：

ACS; NSTEMI; acute myocardial infarction; STEMI; ECMO; IABP; Tandem; Impella; heart failure; hemodynamics; mechanical circulatory support; shock; cardiogenic; MECHANICAL CIRCULATORY SUPPORT; INTRAAORTIC BALLOON COUNTERPULSATION; ASSIST DEVICE; CARDIAC POWER; INFARCTION; RATIONALE; MORTALITY; DESIGN; TRIAL; PUMP;

D O I：

10.1002/ccd.28307

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background The National Cardiogenic Shock Initiative is a single-arm, prospective, multicenter study to assess outcomes associated with early mechanical circulatory support (MCS) in patients presenting with acute myocardial infarction and cardiogenic shock (AMICS) treated with percutaneous coronary intervention (PCI). Methods Between July 2016 and February 2019, 35 sites participated and enrolled into the study. All centers agreed to treat patients with AMICS using a standard protocol emphasizing invasive hemodynamic monitoring and rapid initiation of MCS. Inclusion and exclusion criteria mimicked those of the "SHOCK" trial with an additional exclusion criteria of intra-aortic balloon pump counter-pulsation prior to MCS. Results A total of 171 consecutive patients were enrolled. Patients had an average age of 63 years, 77% were male, and 68% were admitted with AMICS. About 83% of patients were on vasopressors or inotropes, 20% had a witnessed out of hospital cardiac arrest, 29% had in-hospital cardiac arrest, and 10% were under active cardiopulmonary resuscitation during MCS implantation. In accordance with the protocol, 74% of patients had MCS implanted prior to PCI. Right heart catheterization was performed in 92%. About 78% of patients presented with ST-elevation myocardial infarction with average door to support times of 85 +/- 63 min and door to balloon times of 87 +/- 58 min. Survival to discharge was 72%. Creatinine >= 2, lactate >4, cardiac power output (CPO) <0.6 W, and age >= 70 years were predictors of mortality. Lactate and CPO measurements at 12-24 hr reliably predicted overall mortality postindex procedure. Conclusion In contemporary practice, use of a shock protocol emphasizing best practices is associated with improved outcomes.

引用

页码：1173 / 1183

页数：11

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