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Hemodynamic monitoring in Cardiogenic Shock

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Journal of Intensive Medicine 2023年第2期3卷 104-113页

作者： Olfa Hamzaoui Florence Boissier Service de Médecine Intensive Réanimation Hopital Robert DebréUniversitéde ReimsReims 51092France UnitéHERVI Hémostase et Remodelage Vasculaire Post-IschémieEA 3801Reims 51092France Médecine Intensive Réanimation H?pital Universitaire de PoitiersPoitiers 90577France INSERM CIC 1402(ALIVE Group) Universitéde PoitiersPoitiers 90577France

Cardiogenic Shock(CS)is a life-threatening condition characterized by acute end-organ hypoperfusion due to inadequate cardiac output that can result in multiorgan failure,which may lead to death.The diminished cardiac output in CS leads to systemic hypoperfusion and maladaptive cycles of ischemia,inflammation,vasoconstriction,and volume overload.Obviously,the optimal management of CS needs to be readjusted in view of the predominant dysfunction,which may be guided by hemodynamic monitoring.Hemodynamic monitoring enables(1)characterization of the type of cardiac dysfunction and the degree of its severity,(2)very early detection of associated vasoplegia,(3)detection and monitoring of organ dysfunction and tissue oxygenation,and(4)guidance of the introduction and optimization of inotropes and vasopressors as well as the timing of mechanical support.It is now well documented that early recognition,classification,and precise phenotyping via early hemodynamic monitoring(e.g.,echocardiography,invasive arterial pressure,and the evaluation of organ dysfunction and parameters derived from central venous catheterization)improve patient outcomes.In more severe disease,advanced hemodynamic monitoring with pulmonary artery catheterization and the use of transpulmonary thermodilution devices is useful to facilitate the right timing of the indication,weaning from mechanical cardiac support,and guidance on inotropic treatments,thus helping to reduce mortality.In this review,we detail the different parameters relevant to each monitoring approach and the way they can be used to support optimal management of these patients.

关键词： Echocardiography Cardiogenic Shock Hemodynamic monitoring Pulmonary artery catheter Transpulmonary thermodilution device

Use of Impella cardiac axial flow pump for Cardiogenic Shock(A newer alternative)-How good is the evidence?

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BIOCELL 2022年第5期46卷 1139-1150页

作者： RAFIQ AHMED BHAT SYED MANZOOR ALI YOOSUF ALI ASHRAF MUHAMMAD HUSSENBOCUS AKANKSHA RATHI JAVAID AKHTER BHAT ABDUL ALEEM KHAN SYED MAQBOOL RAJA SAQIB IQBAL MD MONOWARUL ISLAM YONGSHENG QU YOU ZHANG YUXIAO SUN WENTAO XIAO ABHISHEK TIBREWAL CHUANYU GAO Zhengzhou University People’s Hospital Department of CardiologyFuwai Central China Cardiovascular HospitalZhengzhouChina2 Department of CardiologySuper Speciality DivisionGovernment Medical CollegeSrinagarIndia3 Department of Rheumatology and ImmunologyNanjing Drum Tower Hospital Clinical College of Nanjing Medical UniversityNanjingChina4 Department of Community MedicineVedanta Institute of Medical SciencesPalgharIndia5 State Key Laboratory of Crop Genetics and Germplasm EnhancementNanjing Agricultural UniversityNanjingChina6 Department of OrthopaedicsNanjing First HospitalNanjing Medical UniversityNanjingChina7 Department of PaediatricsBatra Hospital and Medical Research CentreNew DelhiIndia8 Zhengzhou University First Affiliated HospitalZhengzhouChina9 Department of Community MedicineInstitute of Biostatistics and EpidemiologyGurgaonIndia

The adverse outcomes of a ventricular heart failure(left,right or biventricular)caused by Cardiogenic Shock are aggravated by lung oedema and organ mal perfusion.Despite advances in medical sciences,revascularisation and mechanical hemodynamic support have proved ineffective in reducing the mortality rate in such patients.A thorough study of the data available about cardio-vascular diseases reveals that the application of conventional methods of treatment are least helpful to practically restore normal functions of heart when it experiences end-stage systolic ventricular failure.Thus,to overcome the challenges and find alternatives to address this issue,percutaneous ventricular support devices/machines were designed and successfully introduced.These devices have revolutionized the treatment of ventricular heart failures and are now in use all over the world.In this review paper a newer mechanical circulatory support(MCS)device,Impella,has been discussed and compared with a few other devices like(Intra-aortic Balloon Pump(IABP),Extracorporeal Circulation(ECLS)and Veno-arterial Extracorporeal Membrane Oxygenation(VA-ECMO).This article studies the challenges being faced during the treatment of Cardiogenic Shock,and thoroughly discusses the use and effectiveness of Impella Cardiac Axial Pump in each emergency.It can be said that mechanical circulatory support(MCS)device use during percutaneous coronary intervention(PCI)should be individualized based on multiple factors with a recommended use in patients with the greatest potential benefit and a relatively low risk of device-related complications.The current literature suggests that the outcomes of use of Impella and other mechanical circulatory support devices like IABP and VA-ECMO are comparable.Though there seem to be a few advantages of Impella over the others,sufficiently powered,multi-centric,randomised control trials are needed to establish its superiority.

关键词： Cardiogenic Shock Hemodynamic support Impella Cardiac Axial Pump IABP VA-ECMO

Diabetes mellitus, revascularization and outcomes in elderly patients with myocardial infarction-related Cardiogenic Shock

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Journal of Geriatric Cardiology 2020年第10期17卷 604-611页

作者： Miquel Gual Albert Ariza-Solé María García Márquez Cristina Fernández JoséL Bernal Francesc Formiga María-Isabel Barrionuevo JoséC Sánchez-Salado Victòria Lorente Júlia Pascual Isaac Llaó Oriol Alegre Angel Cequier Javier Elola Hospital Universitari de Bellvitge L’Hospitalet de LlobregatBarcelonaSpain Fundación Instituto para la Mejora de la Asistencia Sanitaria MadridSpain Hospital Clínico Universitario San Carlos MadridSpain Hospital Universitario 12 de Octubre MadridSpain

Background The prognostic role of diabetes mellitus(DM)in elderly patients with myocardial infarction-related Cardiogenic Shock(MI-CS)remains controversial.Little information exists about the impact of intensive cardiac care unit(ICCU)and revascularization on outcomes of elderly patients with MI-CS.We aimed to assess the prognostic impact of DM according to age in patients with MI-CS,and to analyze the impact ICCU management and revascularization on in-hospital mortality in MI-CS patients at older ages.Methods Discharge episodes with diagnosis of CS associated with MI were selected from the Spanish National Health System’s Basic Data Set.Centers were classified according to their availability of ICCU.Main outcome measured was in-hospital mortality.Results A total of 23,590 episodes of MI-CS were identified,of whom 12,447(52.8%)were in patients aged≥75 years.The impact of DM on in-hospital mortality was different among age subgroups.While in younger patients,DM was associated to a higher mortality risk(0.52 vs.0.47,OR=1.12,95%CI:1.06–1.18,χ^2<0.001),this association became non-significant in older patients(0.76 vs.0.81,χ^2=0.09).Adjusted mortality rate of MI-CS aged≥75 years was lower in patients admitted to hospitals with ICCU(adjusted mortality rate:74.2%vs.77.7%,P<0.001)and in patients undergoing revascularization(74.9%vs.77.3%,P<0.001).Conclusions Prognostic impact of DM in patients with MI-CS was different according to age,with a significantly lower impact at older ages.The availability of ICCU and revascularization were associated with better outcomes in these complex patients.

关键词： Cardiogenic Shock Diabetes mellitus Myocardial infarction Revascularization The elderly

The role of temporary mechanical circulatory support in de novo heart failure syndromes with Cardiogenic Shock:A contemporary review

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Journal of Intensive Medicine 2023年第2期3卷 89-103页

作者： Stavros Eftychiou Antonis Kalakoutas Alastair Proudfoot Barts Health NHS Trust London E11FRUK Barking Havering and Redbridge University Hospitals NHS TrustRomford RM70AGUK Barts and the London School of Medicine and Dentistry London E12ADUK Department of Perioperative Medicine Barts Heart CentreSt Bartholomew’s HospitalLondon EC1A 7BEUK Queen Mary University of London London EC1M 6BQUK Department of Anaesthesiology and Intensive Care German Heart Centre BerlinBerlin 13353Germany

Cardiogenic Shock(CS)is a complex clinical syndrome with a high mortality rate.It can occur to due to multiple etiologies of cardiovascular disease and is phenotypically heterogeneous.Acute myocardial infarction-related CS(AMI-CS)has historically been the most prevalent cause,and thus,research and guidance have focused primarily on this.Recent data suggest that the burden of non-ischemic CS is increasing in the population of patents requiring intensive care admission.There is,however,a paucity of data and guidelines to inform the management of these patients who fall into two broad groups:those with existing heart failure and CS and those with no known history of heart failure who present with"de novo"CS.The use of temporary mechanical circulatory support(MCS)has expanded across all etiologies,despite its high cost,resource intensity,complication rates,and lack of high-quality outcome data.Herein,we discuss the currently available evidence on the role of MCS in the management of patients with de novo CS to include fulminant myocarditis,right ventricular(RV)failure,Takotsubo syndrome,post-partum cardiomyopathy,and CS due to valve lesions and other cardiomyopathies.

关键词： Cardiogenic Shock Heart failure Critical care Mechanical circulatory support Takotsubo cardiomyopathy Peripartum cardiomyopathy

Efficacy of Intra-aortic Balloon Pump before versus after Primary Percutaneous Coronary Intervention in Patients with Cardiogenic Shock from ST-elevation Myocardial Infarction

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Chinese Medical Journal 2016年第12期129卷 1400-1405页

作者： Lin Yuan Shao-Ping Nie 1Emergency Critical Care Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China Emergency Critical Care Center Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing 100029 China

Background： Previous studies showed that patients with Cardiogenic Shock （CS） from ST-elevation acute myocardial infarction （STEMI） supported by intra-aortic balloon pump （IABP） before primary percutaneous coronary intervention （PCI） decreased the risk of in-hospital mortality than patients who received IABP after PCI. However, little evidence is available on the optimal order of IABP insertion and primary PCI. The aim of this study was to investigate the impact of the sequence of IABP support and PC1 and its association with major adverse cardiac and cerebrovascular events （MACCEs）. Methods： Data were obtained from 218 consecutive patients with CS due to STEMI in Beijing Anzhen Hospital between 2008 and 2014% who were treated with 1ABP and PCI. The patients were divided into two groups： Group A in whom IABP received before PCI （n = 106） and Group B in whom IABP received after PCI （n = 112）. We evaluated the myocardial perfusion using myocardial blush grade and resolution of ST-segment elevation. The primary endpoint was 12-month risk of MACCE. Results： Most baseline characteristics were similar in patients between the two groups. However, patients received 1ABP before PCI were associated with a delay of door-to-balloon time （DBT） and higher troponin I level （P 〈 0.05）. However, myocardial perfusion was significantly improved in patients treated with IABP before PCI （P 〈 0.05）. Overall, IABP support before PCI was not associated with significantly lower risk of MACCE （P 〉 0.05）. In addition, risk of all-cause mortality, bleeding, and acute kidney injury （AKI） was similar between two groups （P 〉 0.05）. Multivariate analysis showed that DBT （odds ratio [OR] 2.5, 95% confidence interval [C/] 1.1-4.8, P=0.04）, lABP support after PCI （OR 5.7, 95% Cl 2.7-8.4, p〈0.01）, and AKI （OR 7.4, 95% CI 4.9 10.8, P- 0.01） were the independent predictors of mortality at 12-month follow-up. Conclusions： Early IABP insertion before primary PCI is associated with improved myocardial perfusion although DBT increases. IABP support befor

关键词： Acute Myocardial Infarction Cardiogenic Shock Intra-aortic Balloon Counterpulsation Mortality PercutaneousCoronary Intervention

Candidates and allocation time for extracorporeal membrane oxygenation in patients with Cardiogenic Shock

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Emergency and Critical Care Medicine 2021年第2期1卷 75-81页

作者： Baotao Huang Department of Cardiology West China HospitalSichuan UniversityChengduSichuanChina

Extracorporeal membrane oxygenation(ECMO)is a last resort life support in several patients with Cardiogenic Shock.However,appropriate candidates and optimal timing of ECMO initiation need to be established.The present report reviewed relevant literatures to refine the allocation of ECMO in patients with Cardiogenic Shock.The PubMed database was searched from inception to October 5,2020,using the following search terms:"extracorporeal membrane oxygenation"or"mechanical circulatory support"AND"Cardiogenic Shock"or"cardiac arrest"or"myocardial infarction"or"fulminant myocarditis."The etiology of Cardiogenic Shock,widened QRS duration,QTc interval prolongation,cardiac arrest,dynamic narrowing of pulse pressure,and speed of lactate accumulation per unit time can be associated with the course of Cardiogenic Shock,and typically warn that advanced medical circulatory support is required.In the critical moment when the circulatory status deteriorates sharply,an immediate physical examination combined with ready-to-use tools such as monitoring data or blood gas analysis results is crucial for assessing the appropriateness and timing of ECMO initiation.

关键词： Candidate Cardiogenic Shock Cardiovascular Extracorporeal membrane oxygenation Timing

Immediate in-hospital outcomes after percutaneous revascularization of acute myocardial infarction complicated by Cardiogenic Shock

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世界心脏病学杂志:英文版(电子版) 2023年第9期15卷 439-447页

作者： Bashir Ahmed Solangi Jehangir Ali Shah Rajesh Kumar Mahesh Kumar Batra Gulzar Ali Muhammad Hassan Butt Ambreen Nisar Nadeem Qamar Tahir Saghir Jawaid Akbar Sial Department of Adult Cardiology National Institute of Cardiovascular DiseasesKarachi 75510Pakistan

BACKGROUND Cardiogenic Shock(CS)is a life-threatening complication of acute myocardial infarction with high morbidity and mortality rates.Primary percutaneous coro-nary intervention(PCI)has been shown to improve outcomes in patients with CS.AIM To investigate the immediate mortality rates in patients with CS undergoing primary PCI and identify mortality predictors.METHODS We conducted a retrospective analysis of 305 patients with CS who underwent primary PCI at the National Institute of Cardiovascular Diseases,Karachi,Pak-istan,between January 2018 and December 2022.The primary outcome was immediate mortality,defined as mortality within index hospitalization.Uni-variate and multivariate logistic regression analyses were performed to identify predictors of immediate mortality.RESULTS In a sample of 305 patients with 72.8%male patients and a mean age of 58.1±11.8 years,the immediate mortality rate was found to be 54.8%(167).Multivariable analysis identified Killip class IV at presentation[odds ratio(OR):2.0;95%co-nfidence interval(CI):1.2-3.4;P=0.008],Multivessel disease(OR:3.5;95%CI:1.8-6.9;P<0.001),and high thrombus burden(OR:2.6;95%CI:1.4-4.9;P=0.003)as independent predictors of immediate mortality.CONCLUSION Immediate mortality rate in patients with CS undergoing primary PCI remains high despite advances in treatment strategies.Killip class IV at presentation,multivessel disease,and high thrombus burden(grade≥4)were identified as independent predictors of immediate mortality.These findings underscore the need for aggressive management and close monitoring of patients with CS undergoing primary PCI,particularly in those with these high-risk characteristics.

关键词： Acute myocardial infarction Cardiogenic Shock Primary percutaneous coronary intervention Mortality Predictors

The research of HSPB1 in apoptosis,autophagy and Cardiogenic Shock

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实用休克杂志（中英文） 2023年第6期7卷 380-384页

作者： Gu Xiaoxiao Jiang Weibin Chen Fang Liu Xiehong Hunan provincial key laboratory of emergency and critical care metabonomics Hunan provincial peoples hospital(The first affiliated hospital of Hunan normal university) The first affiliated hospital of Hunan normal university ChangshaChina

Cardiogenic Shock(CS)is a common cause of mortality and treatment remains challenging despite advances in therapeutic options.CS is caused by severe impairment of myocardial performance that results in decreased cardiac output,hypoperfusion of the end organ,and hypoxia.Clinically this presents as hypotension refractory to volume resuscitation with features of end-organ hypoperfusion requiring pharmacological or mechanical intervention.Acute myocardial infarction(AMI)accounts for 81%of patients with CS.Heat shock protein family B member 1(HSPB1)is a multifunctional protein induced by various stress factors and has a protective effect on cells.A large number of studies have demonstrated that HSPB1 plays an important role in regulating apoptosis.Recently,some studies have suggested that HSPB1 also participates in the autophagic process.HSPB1 are expressed in many cells of the cardiovascular system such as endothelial cells,cardiac muscle cells,monocytes,and platelets.They are up-regulated in response to inflammation,oxidative stress,or ischemia and protect cells against extracellular stress factors.Here,we explore the involvement of HSPB1 in apoptosis,autophagy,and CS.We speculate that HSPB1 may exert its anti-myocardial injury role via the regulation of apoptosis and autophagy;this may provide the basis for the development of new approaches for the prevention and treatment of CS.

关键词： Cardiogenic Shock Acute myocardial infarction HSPB1 Endothelial cells Cardiac muscle cells Apoptosis Autophagy

Temporary coronary sinus pacing to improve ventricular dyssynchrony with Cardiogenic Shock: A case report

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World Journal of Clinical Cases 2021年第20期9卷 5562-5567页

作者： Teressa Reanne Ju Hsin Tseng Hsin-Ti Lin Alexander Lee Wang Chi Chan Lee Yi-Ching Lai Department of Internal Medicine NewYork-Presbyterian Queens HospitalQueensNY 11355United States School of Medicine China Medical UniversityTaichung City 40447Taiwan Department of Critical Care Medicine Guam Regional Medical CityDededo 96929Guam Department of Cardiology Division of Internal MedicineChina Medical University HospitalTaichung City 40447Taiwan

BACKGROUND Temporary transvenous pacing through the coronary sinus is a novel approach rarely used in treating unstable bradycardia.This modality could provide cardiac pacing while achieving better ventricular synchrony.We present a case who received cardiac pacing through the coronary sinus and provide a summary of evidence in the current literature.CASE SUMMARY A 55-year-old woman with a history of advanced heart failure was admitted to the rehabilitation ward after a recent stroke.During hospitalization,she had paroxysmal atrial fibrillation with rapid ventricular response resulting from fluid overload.While atrial fibrillation was spontaneously reversed to sinus rhythm after diuresis,she developed multiple episodes of polymorphic ventricular tachycardia along with sinus bradycardia and prolonged QTc interval.She became hypotensive despite appropriate medical management.Pacing through her implantable cardioverter-defibrillator was attempted but worsened her hypotension.Ventricular dyssynchrony was suspected.Temporary transvenous atrial pacing through the coronary sinus was performed,which stabilized her blood pressure and improved end-organ perfusion.A permanent biventricular pacemaker was later implanted,and she was safely discharged to a nursing home.CONCLUSION Temporary transvenous pacing through the coronary sinus,a novel approach to treat unstable bradycardia,may reduce ventricular dyssynchrony.

关键词： Cardiac resynchronization Artificial pacemaker Coronary sinus Heart failure Cardiogenic Shock Case report