Pulse Brain · Growing Health Evidence Index
Tier 3 — Observational / field trialPeer-reviewed

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

Mir B. Basir, Navin K. Kapur, Kirit Patel, Murad A. Salam, Theodore Schreiber, Amir Kaki, Ivan Hanson, Steve Almany, Steve Timmis, Simon Dixon, Brian Kolski, Josh Todd, Shaun Senter, Steven P. Marso, David Lasorda, Charles Wilkins, Thomas LaLonde, Antonious Attallah, Timothy J. Larkin, Allison Dupont, J. Jeffrey Marshall, Nainesh Patel, Tjuan Overly, Michael Green, Behnam Tehrani, Alexander G. Truesdell, Rahul Sharma, Yasir Akhtar, Thomas McRae, Brian O’Neill, John Finley, Ayaz Rahman, Malcolm Foster, Raza Askari, Andrew M. Goldsweig, Scott Martin, Aditya Bharadwaj, Matheen Khuddus, Christopher Caputo, Denes Korpas, Ian Cawich, David McAllister, Nimrod Blank, M. Chadi Alraies, Ruth Fisher, Akshay Khandelwal, Khaldoon Alaswad, Alejandro Lemor, Tyrell Johnson, Michael Hacala, William W. O’Neill, on behalf of the National Cardiogenic Shock Initiative Investigators

Catheterization and Cardiovascular Interventions · 2019

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Summary

This prospective multicenter study of 171 patients with acute myocardial infarction and cardiogenic shock evaluated outcomes associated with a standardised shock protocol emphasising early mechanical circulatory support and invasive haemodynamic monitoring. Overall survival to discharge was 72%. The study identified elevated creatinine, elevated lactate, reduced cardiac power output, and advanced age as independent predictors of mortality, with lactate and cardiac power output measurements at 12–24 hours providing reliable prognostic value. The findings suggest that protocolised management of cardiogenic shock improves contemporary outcomes.

UK applicability

The findings are applicable to UK cardiology practice, as the study demonstrates a transferable protocolised approach to acute cardiogenic shock management that could inform similar standardised protocols in UK cardiac centres. However, outcomes may vary depending on local resources, expertise with mechanical circulatory support devices, and healthcare system factors.

Key measures

Survival to discharge (primary outcome); creatinine ≥2 mg/dL, lactate >4 mmol/L, cardiac power output <0.6 W, age ≥70 years (mortality predictors); door-to-support time and door-to-balloon time; lactate and cardiac power output measurements at 12–24 hours post-procedure

Outcomes reported

The study measured survival to discharge and identified predictors of mortality in acute myocardial infarction patients with cardiogenic shock treated with early mechanical circulatory support. Clinical parameters including creatinine, lactate, cardiac power output, and age were assessed as mortality predictors.

Theme
General food systems / other
Subject
Other / interdisciplinary
Study type
Research
Study design
Single-arm prospective multicenter cohort study
Source type
Peer-reviewed study
Status
Published
Geography
United States
System type
Human clinical
DOI
10.1002/ccd.28307
Catalogue ID
SNmoj44ac7-qsw1l2

Topic tags

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