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 journalArticlepeer-review

48 Scopus citations

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

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

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