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Comparative Study
. 2019 Jun 1;93(7):1173-1183.
doi: 10.1002/ccd.28307. Epub 2019 Apr 25.

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

Mir B Basir  1 , Navin K Kapur  2 , Kirit Patel  3 , Murad A Salam  3 , Theodore Schreiber  4 , Amir Kaki  4 , Ivan Hanson  5 , Steve Almany  5 , Steve Timmis  5 , Simon Dixon  5 , Brian Kolski  6 , Josh Todd  7 , Shaun Senter  8 , Steven Marso  9 , David Lasorda  10 , Charles Wilkins  11 , Thomas Lalonde  4 , Antonious Attallah  4 , Timothy Larkin  12 , Allison Dupont  13 , Jeffrey Marshall  13 , Nainesh Patel  14 , Tjuan Overly  15 , Michael Green  16 , Behnam Tehrani  17 , Alexander G Truesdell  17 , Rahul Sharma  18 , Yasir Akhtar  19 , Thomas McRae 3rd  20 , Brian O'Neill  21 , John Finley  22 , Ayaz Rahman  23 , Malcolm Foster  24 , Raza Askari  25 , Andrew Goldsweig  26 , Scott Martin  27 , Aditya Bharadwaj  28 , Matheen Khuddus  29 , Christopher Caputo  29 , Denes Korpas  30 , Ian Cawich  31 , David McAllister  32 , Nimrod Blank  33 , M Chadi Alraies  33 , Ruth Fisher  1 , Akshay Khandelwal  1 , Khaldoon Alaswad  1 , Alejandro Lemor  1 , Tyrell Johnson  1 , Michael Hacala  1 , William W O'Neill  1 ; National Cardiogenic Shock Initiative Investigators
Affiliations
Comparative Study

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

Mir B Basir et al. Catheter Cardiovasc Interv. .

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.

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

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