BACKGROUND AND OBJECTIVES: The relevance of the use of intra-aortic balloon pump (IABP) in cardiogenic shock (CS) has been discussed over the past years. The aim of this study is to describe a single-centre 10-year experience with IABP and analyse the risk factors for 30-day mortality. METHODS: The data for this single-centre, observational, retrospective study were drawn from records dated from January 2012 to May 2022 pertaining to patients presenting with CS, treated with IABP and hospitalised at the Department of Acute Cardiology, Institute for Clinical and Experimental Medicine, Prague. RESULTS: Among the patients included in the study, 87% patients presented with newly developed heart failure. The leading cause of CS was acute myocardial infarction accounting for 86% of cases. Hospital mortality was recorded at 39% and the 30-day mortality reached 43%. Upon multi-variable analysis, only the vasoactive inotropic score on day 5 emerged as a statistically significant predictor for 30-day mortality (p=0.0055). Cox regression analysis revealed that the presence of mechanical complications was the only variable identified as yielding a statistically significant impact on the 30-day survival (Log-rank p=0.014, HR 2.19, 95% CI: 1.15‒4.15). There was no statistically significant difference in the 30-day mortality across the SCAI classes. CONCLUSION: The main cause of CS was a newly developed acute heart failure secondary to acute myocardial infarction. Despite the implementation of mechanical circulatory support, both in-hospital and 30-day mortality rates remained high. Increased vasoactive inotropic score and presence of mechanical complications were identified as significant predictors the 30-day survival (Tab. 6, Fig. 1, Ref. 36). Text in PDF www.elis.sk Keywords: cardiogenic shock, IABP, risk factors, mortality, Czech Republic, AMICS.
- MeSH
- infarkt myokardu komplikace mortalita MeSH
- intraaortální balónková pumpa * MeSH
- kardiogenní šok * mortalita terapie etiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mortalita v nemocnicích * MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- srdeční selhání mortalita terapie komplikace MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- Geografické názvy
- Česká republika MeSH
BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used in patients with cardiogenic shock despite the lack of evidence from adequately powered randomised clinical trials. Three trials reported so far were underpowered to detect a survival benefit; we therefore conducted an individual patient-based meta-analysis to assess the effect of VA-ECMO on 30-day death rate. METHODS: Randomised clinical trials comparing early routine use of VA-ECMO versus optimal medical therapy alone in patients presenting with infarct-related cardiogenic shock were identified by searching MEDLINE, Cochrane Central Register of Controlled Trials, Embase, and trial registries until June 12, 2023. Trials were included if at least all-cause death rate 30 days after in-hospital randomisation was reported and trial investigators agreed to collaborate (ie, providing individual patient data). Odds ratios (ORs) as primary outcome measure were pooled using logistic regression models. This study is registered with PROSPERO (CRD42023431258). FINDINGS: Four trials (n=567 patients; 284 VA-ECMO, 283 control) were identified and included. Overall, there was no significant reduction of 30-day death rate with the early use of VA-ECMO (OR 0·93; 95% CI 0·66-1·29). Complication rates were higher with VA-ECMO for major bleeding (OR 2·44; 95% CI 1·55-3·84) and peripheral ischaemic vascular complications (OR 3·53; 95% CI 1·70-7·34). Prespecified subgroup analyses were consistent and did not show any benefit for VA-ECMO (pinteraction ≥0·079). INTERPRETATION: VA-ECMO did not reduce 30-day death rate compared with medical therapy alone in patients with infarct-related cardiogenic shock, and an increase in major bleeding and vascular complications was observed. A careful review of the indication for VA-ECMO in this setting is warranted. FUNDING: Foundation Institut für Herzinfarktforschung.
- MeSH
- intraaortální balónková pumpa MeSH
- kardiogenní šok * etiologie terapie MeSH
- krvácení etiologie MeSH
- lidé MeSH
- logistické modely MeSH
- mimotělní membránová oxygenace * škodlivé účinky MeSH
- randomizované kontrolované studie jako téma MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- práce podpořená grantem MeSH
AIMS: Despite its high incidence and mortality risk, there is no evidence-based treatment for non-ischaemic cardiogenic shock (CS). The aim of this study was to evaluate the use of mechanical circulatory support (MCS) for non-ischaemic CS treatment. METHODS AND RESULTS: In this multicentre, international, retrospective study, data from 890 patients with non-ischaemic CS, defined as CS due to severe de-novo or acute-on-chronic heart failure with no need for urgent revascularization, treated with or without active MCS, were collected. The association between active MCS use and the primary endpoint of 30-day mortality was assessed in a 1:1 propensity-matched cohort. MCS was used in 386 (43%) patients. Patients treated with MCS presented with more severe CS (37% vs. 23% deteriorating CS, 30% vs. 25% in extremis CS) and had a lower left ventricular ejection fraction at baseline (21% vs. 25%). After matching, 267 patients treated with MCS were compared with 267 patients treated without MCS. In the matched cohort, MCS use was associated with a lower 30-day mortality (hazard ratio 0.76, 95% confidence interval 0.59-0.97). This finding was consistent through all tested subgroups except when CS severity was considered, indicating risk reduction especially in patients with deteriorating CS. However, complications occurred more frequently in patients with MCS; e.g. severe bleeding (16.5% vs. 6.4%) and access-site related ischaemia (6.7% vs. 0%). CONCLUSION: In patients with non-ischaemic CS, MCS use was associated with lower 30-day mortality as compared to medical therapy only, but also with more complications. Randomized trials are needed to validate these findings.
- MeSH
- funkce levé komory srdeční MeSH
- intraaortální balónková pumpa metody MeSH
- kardiogenní šok etiologie terapie MeSH
- lidé MeSH
- podpůrné srdeční systémy * škodlivé účinky MeSH
- retrospektivní studie MeSH
- srdeční selhání * komplikace MeSH
- tepový objem MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
Ruptúra voľnej steny myokardu je v súčasnosti raritná, ale veľmi závažná komplikácia akútneho infarktu myokardu s vysokou mortalitou. V našej práci prezentujeme prípad 64-ročnej pacientky s touto devastujúcou komplikáciou po prednom infarkte myokardu s ST eleváciami (STEMI) s protrahovanou dobou ischémie. Pacientka v kritickom stave bola kontraindikovaná na kardiochirurgický výkon vzhľadom na prohibitívne operačné riziko a predpokladanú infaustnú prognózu. Opisujeme náš terapeutický postup pozostávajúci z okamžitej perikardiálnej drenáže, vazoaktívnej a inotropnej podpory, zavedenia intraaortálnej balónkovej kontrapulzácie a použitia kontinuálnej veno‐venóznej hemodialýzy. Na tejto kombinovanej liečbe došlo k stabilizácii stavu s postupným zlepšením a pacientka bola schopná návratu do bežného života. Po niekoľkých mesiacoch následne podstúpila elektívnu implantáciu trvalej mechanickej podpory obehu ako premostenie k transplantácii srdca.
Myocardial free wall rupture is a rare, but serious complication of acute myocardial infarction with high mortality. We present a case of a 64-year-old patient with this devastating complication of an anterior ST segment elevation myocardial infarction (STEMI) with a prolonged time delay. Cardiac surgery was not performed due to prohibitive surgical risk and predicted poor prognosis. We describe our successful therapeutic intervention consisting of immediate pericardial drainage, vasoactive and inotropic support, intraaortic balloon pump placement and continuous veno-venous hemodialysis. This combined therapy led to patient stabilization and after incremental clinical improvement the patient was able to return to a normal life. After several months a long-term mechanical circulatory support was implanted as a bridge to heart transplant.
- MeSH
- infarkt myokardu s elevacemi ST úseků * diagnóza komplikace terapie MeSH
- intraaortální balónková pumpa MeSH
- koronární angioplastika MeSH
- lidé středního věku MeSH
- lidé MeSH
- nepravé aneurysma diagnóza etiologie terapie MeSH
- péče o pacienty v kritickém stavu MeSH
- poinfarktová ruptura srdce * diagnóza komplikace terapie MeSH
- srdeční tamponáda diagnóza etiologie terapie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
OBJECTIVES: To compare the outcomes of patients with postcardiotomy shock treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) only compared with VA-ECMO and intra-aortic balloon pump (IABP). DESIGN: A retrospective multicenter registry study. SETTING: At 19 cardiac surgery units. PARTICIPANTS: A total of 615 adult patients who required VA-ECMO from 2010 to 2018. The patients were divided into 2 groups depending on whether they received VA-ECMO only (ECMO only group) or VA-ECMO plus IABP (ECMO-IABP group). MEASUREMENTS AND MAIN RESULTS: The overall series mean age was 63 ± 13 years, and 33% were female. The ECMO-only group included 499 patients, and 116 patients were in the ECMO-IABP group. Urgent and/or emergent procedures were more common in the ECMO-only group. Central cannulation was performed in 47% (n = 54) in the ECMO-IABP group compared to 27% (n = 132) in the ECMO-only group. In the ECMO-IABP group, 58% (n = 67) were successfully weaned from ECMO, compared to 46% (n = 231) in the ECMO-only group (p = 0.026). However, in-hospital mortality was 63% in the ECMO-IABP group compared to 65% in the ECMO-only group (p = 0.66). Among 114 propensity score-matched pairs, ECMO-IABP group had comparable weaning rates (57% v 53%, p = 0.51) and in-hospital mortality (64% v 58%, p = 0.78). CONCLUSIONS: This multicenter study showed that adjunctive IABP did not translate into better outcomes in patients treated with VA-ECMO for postcardiotomy shock.
- MeSH
- dospělí MeSH
- intraaortální balónková pumpa metody MeSH
- kardiochirurgické výkony * škodlivé účinky MeSH
- kardiogenní šok etiologie terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mimotělní membránová oxygenace * metody MeSH
- podpůrné srdeční systémy * MeSH
- retrospektivní studie MeSH
- senioři MeSH
- šok * etiologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
There has been a significant increase in the use of short-term percutaneous ventricular assist devices (pVADs) as acute circulatory support in cardiogenic shock and to provide haemodynamic support during interventional procedures, including high-risk percutaneous coronary interventions. Although frequently considered together, pVADs differ in their haemodynamic effects, management, indications, insertion techniques, and monitoring requirements. This consensus document summarizes the views of an expert panel by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) and the Association for Acute Cardiovascular Care (ACVC) and appraises the value of short-term pVAD. It reviews the pathophysiological context and possible indications for pVAD in different clinical settings and provides guidance regarding the management of pVAD based on existing evidence and best current practice.
- MeSH
- hemodynamika MeSH
- intraaortální balónková pumpa MeSH
- kardiogenní šok terapie MeSH
- konsensus MeSH
- koronární angioplastika * MeSH
- lidé MeSH
- podpůrné srdeční systémy * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Patients with cardiogenic shock (CS) needing temporary circulatory support (TCS) have poor survival rates after implantation of durable ventricular assist device (dVAD). We aimed to characterize post-dVAD adverse event burden and survival rates in patients requiring pre-operative TCS. METHOD: We analyzed 13,511 adults (Interagency Registry for Mechanically Assisted Circulatory Support [INTERMACS] Profiles 1-3) with continuous-flow dVADs in International Society for Heart and Lung Transplantation Registry for Mechanically Assisted Circulatory Support (2013-2017) according to the need for pre-operative TCS (n = 5,632) vs no TCS (n = 7,879). Of these, 726 (5.4%) had biventricular assist devices (BiVAD). Furthermore, we compared prevalent rates (events/100 patient-months) of bleeding, device-related infection, hemorrhagic and ischemic cerebrovascular accidents (hemorrhagic cerebral vascular accident [hCVA], and ischemic cerebral vascular accident [iCVA]) in early (<3 months) and late (≥3 months) post-operative periods. RESULTS: TCS included extracorporeal membrane oxygenation (ECMO) (n = 1,138), intra-aortic balloon pump (IABP) (n = 3,901), and other TCS (n = 593). Within 3 post-operative months, there were more major bleeding and cerebrovascular accidents (CVAs) in patients with pre-operative ECMO (events/100 patient-months rates: bleeding = 19, hCVA = 1.6, iCVA = 2.8) or IABP (bleeding = 17.3, hCVA = 1.5, iCVA = 1.5) vs no TCS (bleeding = 13.2, hCVA = 1.1, iCVA = 1.2, all p < 0.05). After 3 months, adverse events were lower and similar in all groups. Patients with ECMO had the worst short- and long-term survival rates. Patients with BiVAD had the worst survival rate regardless of need for pre-operative TCS. CVA and multiorgan failures were the common causes of death for patients with TCS and patients without TCS. CONCLUSIONS: Patients requiring TCS before dVAD had a sicker phenotype and higher rates of early post-operative adverse events than patients without TCS. ECMO was associated with very high early ischemic stroke, bleeding, and mortality. The extreme CS phenotype needing ECMO warrants a higher-level profile status, such as INTERMACS "0."
- MeSH
- celosvětové zdraví MeSH
- intraaortální balónková pumpa škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- mimotělní membránová oxygenace škodlivé účinky MeSH
- míra přežití trendy MeSH
- podpůrné srdeční systémy škodlivé účinky MeSH
- registrace * MeSH
- senioři MeSH
- srdeční selhání mortalita terapie MeSH
- transplantace srdce * MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
Pod pojem mechanické podporné systémy srdca spadajú zariadenia, ktoré dokážu podporiť alebo aj úplne nahradiť činnosť srdca ako pumpy. Ich technická konštrukcia je rôznorodá, ale základný funkčný princíp či cieľ je jednotný a tým je zabezpečiť prečerpávanie okysličenej krvi do arteriálneho riečiska. Zlyhávanie srdca so známkami kardiogénneho šoku či už pri akútnej lézii myokardu alebo v kontexte chronického srdcového zlyhávania je syndróm s veľmi zlou prognózou. Jediným riešením je v súčasnosti použitie zariadenia, ktoré preberie činnosť srdca. Podľa základného liečebného zámeru ich rozdeľujeme na 1. krátkodobé - aplikované s prvotným zámerom zabezpečiť cirkuláciu do zotavenia srdca (bridge to recovery) alebo do obdobia rozhodnutie o ďalšej liečbe (bridge to decision) a 2. dlohodobé, ktorých cieľom je nahradiť činnosť srdca do doby transplantácie (brigdge to transplant) alebo definitívne ako jeden zo spôsobov liečby pokročilého srdcového zlyhávania (destination therapy). Krátkodobé podpory , sú väčšinou prístroje, pri ktorých sú mechanické komponenty (čerpadlá) uložené extrakorporálne. U dlhodobých mechanických podpôr, kde sa plánuje dlhšie čakanie a nezávislý život s prístrojom v ambulantných podmienkach, sú mechanické komponenty (čerpadlo) umiestnené intratorakálne. Extrakorporálne ostávajú elektronické ovládače na zdroje energie. Článok poskytuje stručný prehľad základných princípov a výsledkom použitia krátkodobých aj dlhodobých mechanických podpôr cirkulácie.
Severe heart failure with signs of cardiogenic shock, whether in cases of acute myocardial lesion or in the context of chronic heart failure, is a syndrome with a very poor prognosis. The only solution today is the use of a device that takes over the heart s function. Mechanical circulatory supports are devices designed in a variety of ways to support or replace heart function as pumps, to a greater or lesser extent, for a longer or shorter period of time. In acute conditions, short-term support is being used to create a setting for myocardial recovery and/or a decision on further treatment. In highly selected patients with terminal chronic heart failure, the implantation of a long-term left ventricular assist device for bridging to heart transplantation or as a definitive treatment solution of left ventricular failure is usually indicated. The article provides a brief overview of the basic principles and results of the use of both short- and long-term mechanical circulatory support.
- MeSH
- dysfunkce levé srdeční komory terapie MeSH
- infarkt myokardu diagnóza terapie MeSH
- intraaortální balónková pumpa přístrojové vybavení MeSH
- lidé MeSH
- mimotělní membránová oxygenace přístrojové vybavení MeSH
- nemoci srdce * terapie MeSH
- podpůrné srdeční systémy * MeSH
- srdeční selhání terapie MeSH
- transplantace srdce MeSH
- umělé srdce MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
For patients with myocardial infarct-related cardiogenic shock (CS), urgent percutaneous coronary intervention is the recommended treatment strategy to limit cardiac and systemic ischemia. However, a specific therapeutic intervention is often missing in non-ischemic CS cases. Though drug treatment with inotropes and/or vasopressors may be required to stabilize the patient initially, their ongoing use is associated with excess mortality. Coronary intervention in unstable patients often leads to further hemodynamic compromise either during or shortly after revascularization. Support devices like the intra-aortic balloon pump failed to improve clinical outcomes in infarct-related CS. Currently, more powerful and active hemodynamic support devices unloading the left ventricle such as transvalvular microaxial pumps are available and are being increasingly used. However, as for other devices large randomized trials are not yet available, and device use is based on registry data and expert consensus. In this article, a multidisciplinary group of experienced users of transvalvular microaxial pumps outlines the pathophysiological background on hemodynamic changes in CS, the available mechanical support devices, and current guideline recommendations. Furthermore, different hemodynamic situations in several case-based scenarios are used to illustrate candidate settings and to provide the theoretic and scientific rationale for left-ventricular unloading in these scenarios. Finally, organization of shock networks, monitoring, weaning, and typical complications and their prevention are discussed.
- MeSH
- hemodynamika fyziologie MeSH
- intraaortální balónková pumpa metody trendy MeSH
- kardiogenní šok diagnóza epidemiologie terapie MeSH
- lidé MeSH
- mimotělní membránová oxygenace metody trendy MeSH
- podpůrné srdeční systémy trendy MeSH
- srdeční selhání diagnóza epidemiologie terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Geografické názvy
- Evropa MeSH
