Cardiogenic Shock Management: International Survey of Contemporary Practices

Angie S. Lobo, Yader Sandoval, Jose P. Henriques, Stavros G. Drakos, Iosif Taleb, Jayant Bagai, Mauricio G. Cohen, Yiannis S. Chatzizisis, Benjamin Sun, Katarzyna Hryniewicz, Peter M. Eckman, Holger Thiele, Emmanouil S. Brilakis

Research output: Contribution to journalReview articlepeer-review

Abstract

Background. Limited data exist on current cardiogenic shock (CS) management strategies. Methods. A 48-item open- A nd closed-ended question survey on the diagnosis and management of CS. Result. A total of 211 respondents (3.2%) completed the survey, including 64% interventional cardiologists, 14% general cardiologists, 11% advanced heart failure cardiologists, 5% intensivists, 3% cardiothoracic surgeons; the remainder were internists, emergency medicine, and other physicians. Nearly half (45%) reported practicing at sites without advanced heart failure support/resources, with neither durable ventricular assist devices nor heart transplant available; 16% practice at sites without on-site cardiac surgery and 6% do not offer 24/7 percutaneous coronary intervention (PCI) coverage. The majority (70%) practice in closed intensive care units with multidisciplinary rounding (73%), cardiologists frequently involved in patient care (89%), and involving cardiology-intensivist co-management (41%). Over half (55%) reported use of CS protocols, 61% reported routine arterial line use, 25% reported routine use of pulmonary artery catheter use to guide management and 9% did not. The preferred vasopressor and/or inotrope was norepinephrine (68%). For coronary angiography and PCI, 53% use transradial access, 72% only revascularize the culprit vessel, and 44% institute mechanical circulatory support (MCS) prior to revascularization. Percutaneous MCS availability was as follows: Intra-aortic balloon pump (92%), Impella (78%), peripheral veno-arterial extracorporeal membrane oxygenation (66%), and TandemHeart (28%). Most respondents (58%) do not use a scoring system for risk stratification and most (62%) reported that CS-specific cardiac rehabilitation programs were unavailable at their sites. Conclusion. Wide variation exists in the care delivered and/or resources available for patients with CS. Our survey suggests opportunities for standardization of care.

Original languageEnglish (US)
Pages (from-to)371-374
Number of pages4
JournalJournal of Invasive Cardiology
Volume32
Issue number10
StatePublished - Oct 2020

Keywords

  • Heart failure
  • Mechanical circulatory support
  • Risk stratification
  • Shock

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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