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Auffret V, Cottin Y, Leurent G, Gilard M, Beer JC, Zabalawi A, Chagué F, Filippi E, Brunet D, Hacot JP, Brunel P, Mejri M, Lorgis L, Rouault G, Druelles P, Cornily JC, Didier R, Bot E, Boulanger B, Coudert I, Loirat A, Bedossa M, Boulmier D, Maza M, Le Guellec M, Puri R, Zeller M, Le Breton H. Predicting the development of in-hospital cardiogenic shock in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: the ORBI risk score. Eur Heart J 2019; 39:2090-2102. [PMID: 29554243 DOI: 10.1093/eurheartj/ehy127] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 02/23/2018] [Indexed: 01/12/2023] Open
Abstract
Aims To derive and validate a readily useable risk score to identify patients at high-risk of in-hospital ST-segment elevation myocardial infarction (STEMI)-related cardiogenic shock (CS). Methods and results In all, 6838 patients without CS on admission and treated by primary percutaneous coronary intervention (pPCI), included in the Observatoire Régional Breton sur l'Infarctus (ORBI), served as a derivation cohort, and 2208 patients included in the obseRvatoire des Infarctus de Côte-d'Or (RICO) constituted the external validation cohort. Stepwise multivariable logistic regression was used to build the score. Eleven variables were independently associated with the development of in-hospital CS: age >70 years, prior stroke/transient ischaemic attack, cardiac arrest upon admission, anterior STEMI, first medical contact-to-pPCI delay >90 min, Killip class, heart rate >90/min, a combination of systolic blood pressure <125 mmHg and pulse pressure <45 mmHg, glycaemia >10 mmol/L, culprit lesion of the left main coronary artery, and post-pPCI thrombolysis in myocardial infarction flow grade <3. The score derived from these variables allowed the classification of patients into four risk categories: low (0-7), low-to-intermediate (8-10), intermediate-to-high (11-12), and high (≥13). Observed in-hospital CS rates were 1.3%, 6.6%, 11.7%, and 31.8%, across the four risk categories, respectively. Validation in the RICO cohort demonstrated in-hospital CS rates of 3.1% (score 0-7), 10.6% (score 8-10), 18.1% (score 11-12), and 34.1% (score ≥13). The score demonstrated high discrimination (c-statistic of 0.84 in the derivation cohort, 0.80 in the validation cohort) and adequate calibration in both cohorts. Conclusion The ORBI risk score provides a readily useable and efficient tool to identify patients at high-risk of developing CS during hospitalization following STEMI, which may aid in further risk-stratification and thus potentially facilitate pre-emptive clinical decision making.
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Affiliation(s)
- Vincent Auffret
- Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, Center for Clinical Investigation 804, University of Rennes 1, Signal and Image Treatment laboratory (LTSI), National Institute of Health and Medical Research U1099, Rennes, France
| | - Yves Cottin
- Department of Cardiology, University Hospital of Dijon-Burgundy, 5 boulevard Jeanne d'Arc, 21000 Dijon, France
| | - Guillaume Leurent
- Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, Center for Clinical Investigation 804, University of Rennes 1, Signal and Image Treatment laboratory (LTSI), National Institute of Health and Medical Research U1099, Rennes, France
| | - Martine Gilard
- Department of Cardiology, La Cavale Blanche University Hospital, Optimization of physiological Regulations, Science and Technical Training and ResearchUnit, Boulevard Tanguy Prigent, 29200 Brest, France
| | - Jean-Claude Beer
- Department of Cardiology, University Hospital of Dijon-Burgundy, 5 boulevard Jeanne d'Arc, 21000 Dijon, France
| | - Amer Zabalawi
- Department of Cardiology, General Hospital Yves Le Foll, 10 Rue Marcel Proust, 22000 St-Brieuc, France
| | - Frédéric Chagué
- Department of Cardiology, University Hospital of Dijon-Burgundy, 5 boulevard Jeanne d'Arc, 21000 Dijon, France
| | - Emanuelle Filippi
- Department of Cardiology, General Hospital of Atlantic Brittany, 20 Boulevard du Général Maurice Guillaudot, 56017 Vannes, France
| | - Damien Brunet
- Department of Cardiology, Clinic of Fontaine, 1 Rue des Creots, 21121 Fontaine-lès-Dijon, France
| | - Jean-Philippe Hacot
- Department of Cardiology, General Hospital of South Brittany, 5 Avenue Choiseul, 56322 Lorient, France
| | - Philippe Brunel
- Department of Cardiology, Clinic of Fontaine, 1 Rue des Creots, 21121 Fontaine-lès-Dijon, France
| | - Mourad Mejri
- Department of Cardiology, General Hospital Broussais, St-Malo, 1 Rue de la Marne, 35403 France
| | - Luc Lorgis
- Department of Cardiology, University Hospital of Dijon-Burgundy, 5 boulevard Jeanne d'Arc, 21000 Dijon, France
| | - Gilles Rouault
- Department of Cardiology, General Hospital René Théophile Laennec, 14 bis Avenue Yves Thépot, 29107 Quimper, France
| | - Philippes Druelles
- Department of Cardiology, Clinic St-Laurent, 320 Avenue Général George S. Patton, 35700 Rennes, France
| | - Jean-Christophe Cornily
- Department of Cardiology, Clinic Keraudren-Grand Large, 375 Rue Ernestine de Trémaudan, 29220 Brest, France
| | - Romain Didier
- Department of Cardiology, La Cavale Blanche University Hospital, Optimization of physiological Regulations, Science and Technical Training and ResearchUnit, Boulevard Tanguy Prigent, 29200 Brest, France
| | - Emilie Bot
- Department of Medical Emergency, Pontchaillou University Hospital, 2 Rue Henri Le Guilloux, 35033 Rennes, France
| | - Bertrand Boulanger
- Department of Medical Emergency, General Hospital of Atlantic Brittany, 20 Boulevard du Général Maurice Guillaudot, 56017 Vannes, France
| | - Isabelle Coudert
- Department of Medical Emergency, General Hospital Yves Le Foll, 10 Rue Marcel Proust, 22000 St-Brieuc, France
| | - Aurélie Loirat
- Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, Center for Clinical Investigation 804, University of Rennes 1, Signal and Image Treatment laboratory (LTSI), National Institute of Health and Medical Research U1099, Rennes, France
| | - Marc Bedossa
- Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, Center for Clinical Investigation 804, University of Rennes 1, Signal and Image Treatment laboratory (LTSI), National Institute of Health and Medical Research U1099, Rennes, France
| | - Dominique Boulmier
- Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, Center for Clinical Investigation 804, University of Rennes 1, Signal and Image Treatment laboratory (LTSI), National Institute of Health and Medical Research U1099, Rennes, France
| | - Maud Maza
- Department of Cardiology, University Hospital of Dijon-Burgundy, 5 boulevard Jeanne d'Arc, 21000 Dijon, France
| | - Marielle Le Guellec
- Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, Center for Clinical Investigation 804, University of Rennes 1, Signal and Image Treatment laboratory (LTSI), National Institute of Health and Medical Research U1099, Rennes, France
| | - Rishi Puri
- Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, Center for Clinical Investigation 804, University of Rennes 1, Signal and Image Treatment laboratory (LTSI), National Institute of Health and Medical Research U1099, Rennes, France
| | - Marianne Zeller
- EA 7460 Cerebro- and Cardiovascular Physiopathology and Epidemiology, University of Bourgogne-Franche Comté, 7 Boulevard Jeanne d'Arc, 21000 Dijon, France
| | - Hervé Le Breton
- Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, Center for Clinical Investigation 804, University of Rennes 1, Signal and Image Treatment laboratory (LTSI), National Institute of Health and Medical Research U1099, Rennes, France
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Leurent G, Auffret V, Pichard C, Laine M, Bonello L. Is there still a role for the intra-aortic balloon pump in the management of cardiogenic shock following acute coronary syndrome? Arch Cardiovasc Dis 2019; 112:792-798. [DOI: 10.1016/j.acvd.2019.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/23/2019] [Accepted: 04/23/2019] [Indexed: 12/21/2022]
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Delmas C, Orloff E, Bouisset F, Moine T, Citoni B, Biendel C, Porterie J, Carrié D, Galinier M, Elbaz M, Lairez O. Predictive factors for long-term mortality in miscellaneous cardiogenic shock: Protective role of beta-blockers at admission. Arch Cardiovasc Dis 2019; 112:738-747. [PMID: 31155464 DOI: 10.1016/j.acvd.2019.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/08/2019] [Accepted: 04/15/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Despite advances in intensive care medicine, management of cardiogenic shock (CS) remains difficult and imperfect, with high mortality rates, regardless of aetiology. Predictive data regarding long-term mortality rates in patients presenting CS are sparse. AIM To describe prognostic factors for long-term mortality in CS of different aetiologies. METHODS Two hundred and seventy-five patients with CS admitted to our tertiary centre between January 2013 and December 2014 were reviewed retrospectively. Mortality was recorded in December 2016. A Cox proportional-hazards model was used to determine predictors of long-term mortality. RESULTS Most patients were male (72.7%), with an average age of 64±16 years and a history of cardiomyopathy (63.5%), mainly ischaemic (42.3%). Leading causes of CS were myocardial infarction (35.3%), decompensated heart failure (34.2%) and cardiac arrest (20.7%). Long-term mortality was 62.5%. After multivariable analysis, previous use of beta-blockers (hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.41-0.89; P=0.02) and coronary angiography exploration at admission (HR 0.57, 95% CI 0.38-0.86; P=0.02) were associated with a lower risk of long-term mortality. Conversely, age (HR 1.02 per year, 95% CI 1.01-1.04; P<0.001), catecholamine support (HR 1.45 for each additional agent, 95% CI 1.20-1.75; P<0.001) and renal replacement therapy (HR 1.66, 95% CI 1.09-2.55; P=0.02) were associated with an increased risk of long-term mortality. CONCLUSIONS Long-term mortality rates in CS remain high, reaching 60% at 1-year follow-up. Previous use of beta-blockers and coronary angiography exploration at admission were associated with better long-term survival, while age, renal replacement therapy and the use of catecholamines appeared to worsen the prognosis, and should lead to intensification of CS management.
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Affiliation(s)
- Clément Delmas
- Department of cardiology, Rangueil university hospital, 31059 Toulouse, France; Intensive cardiac care unit, Rangueil university hospital, 31059 Toulouse, France.
| | - Elisabeth Orloff
- Department of cardiology, Rangueil university hospital, 31059 Toulouse, France
| | - Frédéric Bouisset
- Department of cardiology, Rangueil university hospital, 31059 Toulouse, France
| | - Thomas Moine
- Department of cardiology, Rangueil university hospital, 31059 Toulouse, France
| | | | - Caroline Biendel
- Department of cardiology, Rangueil university hospital, 31059 Toulouse, France; Intensive cardiac care unit, Rangueil university hospital, 31059 Toulouse, France
| | - Jean Porterie
- Department of cardiovascular surgery, Rangueil university hospital, 31059 Toulouse, France
| | - Didier Carrié
- Department of cardiology, Rangueil university hospital, 31059 Toulouse, France; Purpan medical school, university Paul Sabatier, 31300 Toulouse, France
| | - Michel Galinier
- Department of cardiology, Rangueil university hospital, 31059 Toulouse, France; Rangueil medical school, university Paul Sabatier, 31059 Toulouse, France
| | - Meyer Elbaz
- Department of cardiology, Rangueil university hospital, 31059 Toulouse, France; Rangueil medical school, university Paul Sabatier, 31059 Toulouse, France
| | - Olivier Lairez
- Department of cardiology, Rangueil university hospital, 31059 Toulouse, France; Rangueil medical school, university Paul Sabatier, 31059 Toulouse, France; Cardiac imaging centre, Toulouse university hospital, 31059 Toulouse, France; Department of nuclear medicine, Rangueil university hospital, 31059 Toulouse, France
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Delmas C, Puymirat E, Leurent G, Elbaz M, Manzo-Silberman S, Bonello L, Gerbaud E, Bataille V, Levy B, Lamblin N, Bonnefoy E, Henry P, Roubille F. Design and preliminary results of FRENSHOCK 2016: A prospective nationwide multicentre registry on cardiogenic shock. Arch Cardiovasc Dis 2019; 112:343-353. [PMID: 30982720 DOI: 10.1016/j.acvd.2019.02.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 02/03/2019] [Accepted: 02/19/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Most data on the epidemiology of cardiogenic shock (CS) have come from patients with acute myocardial infarction admitted to intensive cardiac care units (ICCUs). However, CS can have other aetiologies, and could be managed in intensive care units (ICUs), especially the most severe forms of CS. AIM To gather data on the characteristics, management and outcomes of patients hospitalized in ICCUs and ICUs for CS, whatever the aetiology, in France in 2016. METHODS We included all adult patients with CS between April and October 2016 in metropolitan France. CS was defined (at admission or during hospitalization) by: low cardiac output, defined by systolic blood pressure<90mmHg and/or the need for amines to maintain systolic blood pressure>90mmHg and/or cardiac index<2.2L/min/m2; elevation of the left and/or right heart pressures, defined by clinical, radiological, biological, echocardiographic or invasive haemodynamic overload signs; and clinical and/or biological signs of malperfusion (lactate>2mmol/L, hepatic insufficiency, renal failure). RESULTS Over a 6-month period, 772 patients were included in the survey (mean age 65.7±14.9 years; 71.5% men) from 49 participating centres (91.8% were public, and 77.8% of these were university hospitals). Ischaemic trigger was the most common cause (36.3%). CONCLUSIONS To date, FRENSHOCK is the largest CS survey; it will provide a detailed and comprehensive global description of the spectrum and management of patients with CS in a high-income country.
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Affiliation(s)
- Clément Delmas
- Intensive cardiac care unit, cardiology department, university hospital of Rangueil, 31059 Toulouse, France.
| | - Etienne Puymirat
- Cardiology department, hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France
| | - Guillaume Leurent
- Department of Cardiology, CHU Rennes, 35000 Rennes, France; Inserm LTSI-UMR 1099, Rennes university, 35043 Rennes, France
| | - Meyer Elbaz
- Intensive cardiac care unit, cardiology department, university hospital of Rangueil, 31059 Toulouse, France
| | - Stéphane Manzo-Silberman
- Intensive cardiac care unit, cardiology department, Lariboisière university hospital, AP-HP, 75010 Paris, France; UMR S-942, université Paris Diderot, 75010 Paris, France
| | - Laurent Bonello
- Intensive care unit, department of cardiology, hôpital Nord, AP-HM, 13015 Marseille, France; Mediterranean Association for research and studies in cardiology (MARS Cardio), 13015 Marseille, France; Inserm 1263, Inra 1260, Centre for cardiovascular and nutrition research (C2VN), Aix-Marseille university, 13385 Marseille, France
| | - Edouard Gerbaud
- Cardiology intensive care unit and interventional cardiology, hôpital cardiologique du Haut Lévêque, 33600 Pessac, France; Inserm U1045, Bordeaux cardio-thoracic research centre, Bordeaux university, 33607 Bordeaux, France
| | - Vincent Bataille
- Association pour la diffusion de la médecine de prévention (ADIMEP), 31400 Toulouse, France
| | - Bruno Levy
- Pôle cardio-médico-chirurgical, service de réanimation médicale Brabois, CHRU Nancy, 54500 Vandoeuvre-lès-Nancy, France; Inserm U1116, faculté de médecine, université de Lorraine, 54500 Vandoeuvre-lès-Nancy, France
| | - Nicolas Lamblin
- Inserm U1167, institut Pasteur de Lille, CHU Lille, université de Lille, 59019 Lille, France
| | - Eric Bonnefoy
- Hospices Civils de Lyon, université Claude Bernard Lyon 1, 69002 Lyon, France
| | - Patrick Henry
- Intensive cardiac care unit, cardiology department, Lariboisière university hospital, AP-HP, 75010 Paris, France; UMR S-942, université Paris Diderot, 75010 Paris, France
| | - François Roubille
- Inserm, CNRS, PhyMedExp, cardiology department, université de Montpellier, CHU de Montpellier, 34295 Montpellier, France
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Helleu B, Auffret V, Bedossa M, Gilard M, Letocart V, Chassaing S, Angoulvant D, Commeau P, Range G, Prunier F, Sabatier R, Filippi E, Delaunay R, Boulmier D, Le Breton H, Leurent G. Current indications for the intra-aortic balloon pump: The CP-GARO registry. Arch Cardiovasc Dis 2018; 111:739-748. [PMID: 29908713 DOI: 10.1016/j.acvd.2018.03.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 02/08/2018] [Accepted: 03/21/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Intra-aortic balloon pumps (IABPs) have been used routinely since the 1970s. Recently, large randomized trials failed to show that IABP therapy has meaningful benefit, and international recommendations downgraded its place, particularly in cardiogenic shock. AIMS The aim of this registry was to describe the contemporary use of IABP therapy, in light of these new data. METHODS This prospective multicentre registry included 172 patients implanted with an IABP in 19 French cardiac centres in 2015. Baseline characteristics, aetiologies leading to IABP use, and IABP-related and disease-related complications were assessed. In-hospital and 1-year mortality rates were studied. RESULTS A total of 172 patients were included (mean age 65.5±12.0 years; 118 men [68.6%]). The reasons for IABP implantation were mainly haemodynamic (n=107; 62.2%), followed by bridge to revascularization (n=34; 19.8%) and four other "rare" aetiologies (n=29 patients; 16.8%). In-hospital and 1-year mortality rates were 40.7% and 45.8%, respectively. Fourteen patients (8.1%) experienced ischaemic or haemorrhagic complications, which were directly related to the IABP in seven patients (4.1%). CONCLUSIONS Despite current international guidelines regarding the place of IABPs in ischaemic cardiogenic shock without mechanical complications, this aetiology remains the leading cause for its utilization in the contemporary era.
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Affiliation(s)
- Benoit Helleu
- Université Rennes, Department of cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, 35000 Rennes, France
| | - Vincent Auffret
- Université Rennes, Department of cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, 35000 Rennes, France
| | - Marc Bedossa
- Université Rennes, Department of cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, 35000 Rennes, France
| | - Martine Gilard
- EA4324, département de cardiologie, optimisation des régulations physiologiques (ORPhy), UFR sciences et techniques, CHU de Brest, 29200 Brest, France
| | - Vincent Letocart
- L'institut du Thorax, CHU Nantes, service de cardiologie, 44093 Nantes, France
| | - Stephan Chassaing
- Service de cardiologie interventionnelle et d'imagerie cardiaque, clinique Saint-Gatien, 37000 Tours, France
| | - Denis Angoulvant
- EA 4245 and Loire Valley Cardiovascular Collaboration, Service de Cardiologie, CHRU de Tours et Université de Tours, 37000 Tours, France
| | - Philippe Commeau
- Service de cardiologie, polyclinique les Fleurs, 83190 Ollioules, France
| | - Grégoire Range
- Service de cardiologie, Les hôpitaux de Chartres, 28000 Chartres, France
| | - Fabrice Prunier
- Institut Mitovasc, UMR CNRS 6015 - INSERM U1083, Service de cardiologie, CHU d'Angers, Université d'Angers, 49100 Angers, France
| | - Remi Sabatier
- Cardiology Department, University Hospital of Caen, 14033 Caen, France
| | - Emmanuelle Filippi
- Service de cardiologie, centre hospitalier de Vannes, 56000 Vannes, France
| | - Régis Delaunay
- Service de cardiologie, centre hospitalier de Saint-Brieuc, 22000 Saint-Brieuc, France
| | - Dominique Boulmier
- Université Rennes, Department of cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, 35000 Rennes, France; EA4324, département de cardiologie, optimisation des régulations physiologiques (ORPhy), UFR sciences et techniques, CHU de Brest, 29200 Brest, France; L'institut du Thorax, CHU Nantes, service de cardiologie, 44093 Nantes, France
| | - Hervé Le Breton
- Université Rennes, Department of cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, 35000 Rennes, France; EA4324, département de cardiologie, optimisation des régulations physiologiques (ORPhy), UFR sciences et techniques, CHU de Brest, 29200 Brest, France; L'institut du Thorax, CHU Nantes, service de cardiologie, 44093 Nantes, France
| | - Guillaume Leurent
- Université Rennes, Department of cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, 35000 Rennes, France; EA4324, département de cardiologie, optimisation des régulations physiologiques (ORPhy), UFR sciences et techniques, CHU de Brest, 29200 Brest, France; L'institut du Thorax, CHU Nantes, service de cardiologie, 44093 Nantes, France.
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Delmas C, Elbaz M, Bonello L, Biendel C, Bouisset F, Lairez O, Silva S, Marcheix B, Galinier M. Place de l’assistance circulatoire dans le choc cardiogénique en France en 2018 : revue de la littérature et perspectives. MEDECINE INTENSIVE REANIMATION 2018. [DOI: 10.3166/rea-2018-0023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Le choc cardiogénique reste de nos jours une entité mal définie, assez fréquente en pratique clinique (60 000–70 000 cas/an en Europe), dont le pronostic est sombre, avec une mortalité souvent supérieure à 40 % à 30 jours. À travers cette revue de la littérature, nous essaierons de définir cette entité et ses étiologies, avant de parler de son incidence et de son pronostic. L’approche physiopathologique du choc cardiogénique nous permettra par la suite d’approcher sa prise en charge thérapeutique classique (gestion de la volémie, amines inotropes et vasoconstrictives, ventilation) et les limites de cette dernière. Ainsi, nous aborderons les assistances circulatoires et cardiocirculatoires disponibles en France, afin de les envisager au sein d’une stratégie globale de prise en charge du patient en choc cardiogénique. Nous discuterons plus spécifiquement leurs indications ainsi que l’importance du moment d’implantation afin d’optimiser leur efficacité. Enfin, nous évoquerons les assistances actuellement en développement, mais également les nouvelles stratégies thérapeutiques qui pourraient arriver dans les prochaines années.
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Truesdell AG, Tehrani B, Singh R, Desai S, Saulino P, Barnett S, Lavanier S, Murphy C. 'Combat' Approach to Cardiogenic Shock. Interv Cardiol 2018; 13:81-86. [PMID: 29928313 DOI: 10.15420/icr.2017:35:3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The incidence of cardiogenic shock is rising, patient complexity is increasing and patient survival has plateaued. Mirroring organisational innovations of elite military units, our multidisciplinary medical specialists at the INOVA Heart and Vascular Institute aim to combine the adaptability, agility and cohesion of small teams across our large healthcare system. We advocate for widespread adoption of our 'combat' methodology focused on: increased disease awareness, early multidisciplinary shock team activation, group decision-making, rapid initiation of mechanical circulatory support (as appropriate), haemodynamic-guided management, strict protocol adherence, complete data capture and regular after action reviews, with a goal of ending preventable death from cardiogenic shock.
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Affiliation(s)
- Alexander G Truesdell
- Virginia Heart, Falls Church VA, USA.,INOVA Heart and Vascular Institute, Falls Church VA, USA
| | - Behnam Tehrani
- INOVA Heart and Vascular Institute, Falls Church VA, USA
| | - Ramesh Singh
- INOVA Heart and Vascular Institute, Falls Church VA, USA
| | - Shashank Desai
- INOVA Heart and Vascular Institute, Falls Church VA, USA
| | | | - Scott Barnett
- INOVA Heart and Vascular Institute, Falls Church VA, USA
| | | | - Charles Murphy
- INOVA Heart and Vascular Institute, Falls Church VA, USA
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