1
|
Impact of shock aetiology and hospital characteristics on the clinical profile, management and prognosis of patients with non ACS-related cardiogenic shock. Hellenic J Cardiol 2023; 69:16-23. [PMID: 36334704 DOI: 10.1016/j.hjc.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 09/08/2022] [Accepted: 11/01/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND A significant proportion of cases of cardiogenic shock (CS) are due aetiologies other than acute coronary syndromes (non ACS-CS). We assessed differences regarding clinical profile, management, and prognosis according to the cause of CS among nonselected patients with CS from a large nationwide database. METHODS We performed an observational study including patients admitted from the hospitals of the Spanish National Health System (SNHS) with a principal or secondary diagnosis code of CS (2016-2019). Data were obtained from the Minimum Basic Data Set (MBDS). Hospitals were classified according to the availability of cardiology related resources, as well as the availability of Intensive Cardiac Care Unit (ICCU). RESULTS A total of 10,826 episodes of CS were included, of whom 5,495 (50.8%) were non-ACS related. Non ACS-CS patients were younger (71.5 vs. 72.4 years) and had a lower burden of arteriosclerosis-related comorbidities. Non ACS-CS cases underwent less often invasive procedures and presented lower in-hospital mortality (57.1% vs. 61%,p < 0.001). The most common main diagnosis among non ACS-CS was acute decompensation of chronic heart failure (ADCHF) (35.4%). A lower risk-adjusted in-hospital mortality rate was observed in high volume hospitals (52.6% vs. 56.7%; p < 0.001), as well as in centers with ICCU (OR: 0.71; CI 95%: 0.58-0.87; p < 0.001). CONCLUSIONS More than a half of cases of CS were due to non-ACS causes. Non ACS-CS cases are a very heterogeneous group, with different clinical profile and management. Management at high-volume hospitals and availability of ICCU were associated with lower risk adjusted mortality among non ACS-CS patients.
Collapse
|
2
|
Castillo García J, Sánchez Salado JC, Gual Santandreu M, Molina Mazón CS, Blasco Lucas A, Sbraga F, López Sánchez G. Discharge survival of patients undergoing ECMO therapy after ECPR in a third level hospital. ENFERMERIA INTENSIVA 2021; 32:73-78. [PMID: 34099267 DOI: 10.1016/j.enfie.2020.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 03/03/2020] [Indexed: 11/18/2022]
Abstract
GOAL The goal of this study was to assess the survival to hospital discharge in patients after the implementation of venoarterial-extracorporeal membrane oxygenation (VA-ECMO) during cardiopulmonary arrest (simultaneously or during the first six hours after the event) in a Spanish tertiary hospital. METHOD This is a descriptive and retrospective study conducted with patients subjected to VA-ECMO therapy during or after cardiopulmonary resuscitation (CPR) in the last 10 years. The variables were extracted from the electronic medical record of each patient. RESULTS 175 ECMO therapies were implemented, 84% (147) were VA-ECMO, and the indication for 17% (25) was CPR. In 40% (10), ECMO therapy was initiated simultaneously during CPR, and the rest (15) during the first six hours after the event. Survival rates reached 44%. CONCLUSIONS The use of CPR in well-selected patients can improve their survival.
Collapse
Affiliation(s)
- J Castillo García
- Enfermería, Perfusionista, Quirófano, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - J C Sánchez Salado
- Cardiología, Unidad Coronaria, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - M Gual Santandreu
- Cardiología, Unidad Coronaria, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - C S Molina Mazón
- Enfermería, Unidad Coronaria, Supervisión, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - A Blasco Lucas
- Cirugía Cardiaca, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - F Sbraga
- Cirugía Cardiaca, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - G López Sánchez
- Enfermería, Perfusionista, Quirófano, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| |
Collapse
|
3
|
Discharge survival of patients undergoing ECMO therapy after ECPR in a third level hospital. ENFERMERIA INTENSIVA 2020; 32:73-78. [PMID: 33051151 DOI: 10.1016/j.enfi.2020.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 01/21/2020] [Accepted: 03/03/2020] [Indexed: 11/21/2022]
Abstract
GOAL The goal of this study was to assess the survival to hospital discharge in patients after the implementation of venoarterial-extracorporeal membrane oxygenation (VA-ECMO) during cardiopulmonary arrest (simultaneously or during the first six hours after the event) in a Spanish tertiary hospital. METHOD This is a descriptive and retrospective study conducted with patients subjected to VA-ECMO therapy during or after cardiopulmonary resuscitation (ECPR) in the last 10 years. The variables were extracted from the electronic medical record of each patient. RESULTS 175 ECMO therapies were implemented, 84% (147) were VA-ECMO, and the indication for 17% (25) was ECPR. In 40% (10), ECMO therapy was initiated simultaneously during CPR, and the rest (15) during the first six hours after the event. Survival rates reached 44%. CONCLUSIONS The use of CPR in well-selected patients can improve their survival.
Collapse
|
4
|
Sánchez-Salado JC, Lorente V, Alegre O, Llaó I, Blázquez L, Ariza-Solé A. Predictive ability of the CardShock score in patients with profound cardiogenic shock undergoing venoarterial extracorporeal membrane oxygenation support. Med Intensiva 2019; 44:312-315. [PMID: 31060748 DOI: 10.1016/j.medin.2019.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/08/2019] [Accepted: 03/10/2019] [Indexed: 11/26/2022]
Affiliation(s)
- J C Sánchez-Salado
- Unidad de Cuidados Intensivos Cardiológicos, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - V Lorente
- Unidad de Cuidados Intensivos Cardiológicos, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - O Alegre
- Unidad de Cuidados Intensivos Cardiológicos, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - I Llaó
- Unidad de Cuidados Intensivos Cardiológicos, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - L Blázquez
- Unidad de Cuidados Intensivos Cardiológicos, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - A Ariza-Solé
- Unidad de Cuidados Intensivos Cardiológicos, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
| |
Collapse
|
5
|
Burgueño P, González C, Sarralde A, Gordo F. Transporte interhospitalario con membrana de oxigenación extracorpórea: cuestiones a resolver. Med Intensiva 2019; 43:90-102. [DOI: 10.1016/j.medin.2018.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 01/07/2018] [Accepted: 01/19/2018] [Indexed: 12/22/2022]
|
6
|
Ariza-Solé A, Sánchez-Salado JC, Sbraga F, Ortiz D, González-Costello J, Blasco-Lucas A, Alegre O, Toral D, Lorente V, Santafosta E, Toscano J, Izquierdo A, Miralles A, Cequier Á. The role of perioperative cardiorespiratory support in post infarction ventricular septal rupture-related cardiogenic shock. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2018; 9:128-137. [DOI: 10.1177/2048872618817485] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Current guidelines recommend emergency surgical correction in patients with post infarction ventricular septal rupture (PIVSR), but patients with multiorgan failure are commonly managed conservatively because of high surgical risk. We assessed characteristics and outcomes of operated PIVSR patients with or without the use of short-term ventricular assist devices (ST-VADs). We also assessed the impact of a ST-VAD on the performance of surgery Methods: We retrospectively analysed all consecutive patients with PIVSR between January 2004 and May 2017. Baseline clinical characteristics, use of ST-VAD and performance of surgery during admission were assessed. The main outcome measured was in-hospital mortality. Results: A total of 28 patients were included. Mean age was 69.2 years. Most patients (20/28, 71.4%) underwent surgical repair. ST-VADs were used in 11/28 patients (39.3%). This percentage progressively increased across the study period, from 22.2% (2/9) in 2004–2011 to 58.3% (7/12) in 2015–2017 ( p=0.091). Patients undergoing ST-VAD use had poorer INTERMACS status, higher values of creatinine, lactate and alanine aminotransferase and lower left ventricular ejection fraction as compared with operated patients without support. In-hospital mortality did not differ according to the use of ST-VADs in operated patients (27.3% without ST-VAD vs. 22.2% with ST-VAD, p=0.604). All five patients undergoing early preoperative venoarterial extracorporeal membrane oxygenator support and delayed surgery survived at hospital discharge. Conclusions: ST-VAD use increased in patients with PIVSR. Despite a higher risk profile in operated patients undergoing ST-VAD use, mortality was not significantly different in these patients. Early preoperative venoarterial extracorporeal membrane oxygenation should be considered for very high risk PIVSR patients.
Collapse
Affiliation(s)
- Albert Ariza-Solé
- Intensive Cardiac Care Unit, Cardiology Department, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
| | - José C Sánchez-Salado
- Intensive Cardiac Care Unit, Cardiology Department, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
| | - Fabrizio Sbraga
- Heart Surgery Department, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
| | - Daniel Ortiz
- Heart Surgery Department, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
| | - José González-Costello
- Advanced Heart Failure and Heart Transplant Unit, Cardiology Department, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
| | - Arnau Blasco-Lucas
- Heart Surgery Department, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
| | - Oriol Alegre
- Intensive Cardiac Care Unit, Cardiology Department, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
| | - David Toral
- Heart Surgery Department, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
| | - Victòria Lorente
- Intensive Cardiac Care Unit, Cardiology Department, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
| | - Eva Santafosta
- Intensive Care Unit, Bellvitge University Hospital, Barcelona, Spain
| | - Jacobo Toscano
- Heart Surgery Department, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
| | - Andrea Izquierdo
- Intensive Cardiac Care Unit, Cardiology Department, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
| | - Albert Miralles
- Heart Surgery Department, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
| | - Ángel Cequier
- Intensive Cardiac Care Unit, Cardiology Department, Heart Disease Institute, Bellvitge University Hospital, Barcelona, Spain
| |
Collapse
|
7
|
García-Gigorro R, Renes-Carreño E, Pérez-Vela J, Marín-Mateos H, Gutiérrez J, Corrés-Peiretti M, Delgado J, Pérez-de la Sota E, Cortina-Romero J, Montejo-González J. Soporte mecánico con membrana de oxigenación extracorpórea veno-arterial (ECMO-VA): evolución a corto y a largo plazo tras la retirada de la asistencia. Med Intensiva 2017; 41:513-522. [DOI: 10.1016/j.medin.2016.12.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/06/2016] [Accepted: 12/27/2016] [Indexed: 11/26/2022]
|
8
|
ECMO: Past, present and future in critical care. Med Intensiva 2017; 41:511-512. [PMID: 28552461 DOI: 10.1016/j.medin.2017.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/13/2017] [Accepted: 04/21/2017] [Indexed: 11/24/2022]
|