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

on behalf of the National Cardiogenic Shock Initiative Investigators

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1173-1183
Number of pages11
JournalCatheterization and Cardiovascular Interventions
Volume93
Issue number7
DOIs
StatePublished - Jun 1 2019
Externally publishedYes

Fingerprint

Cardiogenic Shock
Shock
Myocardial Infarction
Percutaneous Coronary Intervention
Cardiac Output
Lactic Acid
Out-of-Hospital Cardiac Arrest
Mortality
Cardiopulmonary Resuscitation
Cardiac Catheterization
Heart Arrest
Practice Guidelines
Multicenter Studies
Creatinine
Hemodynamics
Prospective Studies
Survival

Keywords

  • ACS/NSTEMI
  • acute myocardial infarction/STEMI
  • ECMO/IABP/Tandem/Impella
  • heart failure
  • hemodynamics
  • mechanical circulatory support
  • shock, cardiogenic

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Improved Outcomes Associated with the use of Shock Protocols : Updates from the National Cardiogenic Shock Initiative. / on behalf of the National Cardiogenic Shock Initiative Investigators.

In: Catheterization and Cardiovascular Interventions, Vol. 93, No. 7, 01.06.2019, p. 1173-1183.

Research output: Contribution to journalArticle

on behalf of the National Cardiogenic Shock Initiative Investigators. / Improved Outcomes Associated with the use of Shock Protocols : Updates from the National Cardiogenic Shock Initiative. In: Catheterization and Cardiovascular Interventions. 2019 ; Vol. 93, No. 7. pp. 1173-1183.
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abstract = "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.",
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T2 - Updates from the National Cardiogenic Shock Initiative

AU - on behalf of the National Cardiogenic Shock Initiative Investigators

AU - Basir, Mir B.

AU - Kapur, Navin K.

AU - Patel, Kirit

AU - Salam, Murad A.

AU - Schreiber, Theodore

AU - Kaki, Amir

AU - Hanson, Ivan

AU - Almany, Steve

AU - Timmis, Steve

AU - Dixon, Simon

AU - Kolski, Brian

AU - Todd, Josh

AU - Senter, Shaun

AU - Marso, Steven P

AU - Lasorda, David

AU - Wilkins, Charles

AU - Lalonde, Thomas

AU - Attallah, Antonious

AU - Larkin, Timothy

AU - Dupont, Allison

AU - Marshall, Jeffrey

AU - Patel, Nainesh

AU - Overly, Tjuan

AU - Green, Michael

AU - Tehrani, Behnam

AU - Truesdell, Alexander G.

AU - Sharma, Rahul

AU - Akhtar, Yasir

AU - McRae, Thomas

AU - O'Neill, Brian

AU - Finley, John

AU - Rahman, Ayaz

AU - Foster, Malcolm

AU - Askari, Raza

AU - Goldsweig, Andrew

AU - Martin, Scott

AU - Bharadwaj, Aditya

AU - Khuddus, Matheen

AU - Caputo, Christopher

AU - Korpas, Denes

AU - Cawich, Ian

AU - McAllister, David

AU - Blank, Nimrod

AU - Alraies, M. Chadi

AU - Fisher, Ruth

AU - Khandelwal, Akshay

AU - Alaswad, Khaldoon

AU - Lemor, Alejandro

AU - Johnson, Tyrell

AU - Hacala, Michael

PY - 2019/6/1

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N2 - 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.

AB - 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.

KW - ACS/NSTEMI

KW - acute myocardial infarction/STEMI

KW - ECMO/IABP/Tandem/Impella

KW - heart failure

KW - hemodynamics

KW - mechanical circulatory support

KW - shock, cardiogenic

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