Improved Outcomes Associated with the use of Shock Protocols: Updates from the National Cardiogenic Shock Initiative
Catheterization and Cardiovascular Interventions
© 2019 Wiley Periodicals, Inc. 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.
Basir, Mir B.; Kapur, Navin K.; Patel, Kirit; Salam, Murad A.; Schreiber, Theodore; Kaki, Amir; Hanson, Ivan; Almany, Steve; Timmis, Steve; Dixon, Simon; Kolski, Brian; Todd, Josh; Senter, Shaun; Marso, Steven; Lasorda, David; Wilkins, Charles; Lalonde, Thomas; Attallah, Antonious; Larkin, Timothy; Dupont, Allison; Marshall, Jeffrey; Patel, Nainesh; Overly, Tjuan; Green, Michael; Tehrani, Behnam; Truesdell, Alexander G.; Sharma, Rahul; Akhtar, Yasir; McRae, Thomas; O'Neill, Brian; Finley, John; Rahman, Ayaz; and Foster, Malcolm, "Improved Outcomes Associated with the use of Shock Protocols: Updates from the National Cardiogenic Shock Initiative" (2019). Articles. 211.