Cardiogenic Shock, Shock Team, Short Term Mechanical Circulatory Support
Conditions
Keywords
Extra Corporeal Membrane Oxygenation, Cardiogenic Shock, Impella, Shock Team, Long Term Mechanical Circulatory Support
Brief summary
In this before-after monocenter study, the authors teste the hypothesis that the implementation of a dedicated shock team could improve the outcome of patients with refractory cardiogenic shock assisted by mechanical circulatory support.
Detailed description
Short Term Mechanical Circulatory Support (STMCS) are the last resort therapeutics when refractory cardiogenic shock occurs. Growing technical possibilities like impella make the right choice at the right time challenging. At Bordeaux University Hospital, we have gathered the main protagonists which are the surgeon, the interventional cardiologist,and the intensivist as a shock team in January 2013. From that time, diagnosis of refractory cardiogenic shock triggers a multidisciplinary meeting driven by a common algorithm. The objective of this study is to perform a before-after comparison between decision of STMCS for refractory cardiogenic shock without shock team from january 2007 to january 2013 and after implementation of the shock team from April 2013 to April 2019.
Interventions
OTHERstandard of care
retrospective study : standard of care
Sponsors
University Hospital, Bordeaux
Study design
Observational model
OTHER
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Diagnosis of cardiogenic shock * \>1 sign of refractory cardiogenic shock : Dobutamine \>10µg/kg/mn, epinephrine\>0.25µg/kg/mn or Milrinone \> 0.5µg/kg/mn ; ScvO2\<55% ; pO2/FiO2\<100 * No major counter indication to short term mechanical circulatory support : SOFA score \> 15, prolonged cardiac arrest, severe chronic disease, direct LVAD implantation or heart transplantation, counter indication for systemic anticoagulation
Exclusion criteria
* Age \< 18years * Post cardiotomy cardiogenic shock * Implantation of Impella 2.5 alone * Implantation of Intra Aortic Balloon Pump alone
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Vital status | One year after short term mechanical circulatory support initiation | Proportion of patients alive |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Vital status | 30 days after short term mechanical circulatory support initiation | proportion of patients alive |
| Lenght of stay | up to Intensive Care Unit discharge, an average of 15 days | Intensive Care Unit length of stay |
| Long term mechanical circulatory support | up to intensive care unit discharge, an average of 15 days | proportion of patients bridged to long term mechanical circulatory support |
| Heart transplantation | up to intensive care unit discharge, an average of 15 days | proportion of patients bridged to heart transplantation |
| Weaning from short term mechanical circulatory support | up to seven days from weaning attempt | proportion of patients sucessfully weaned from short term mechanical circulatory support |
| New renal replacement therapy | up to intensive care unit discharge, an average of 15 days | proportion of patients needing renal replacement therapy |
| Limb ischaemia | through short term mechanical circulatory support weaning, an average of 6 days | proportion of patients with limb ischaemia |
| Stroke | through short term mechanical circulatory support weaning, an average of 6 days | proportion of patients with stroke |
| Short term mechanical circulatory support duration | through short term mechanical circulatory support weaning, an average of 6 days | Short term mechanical circulatory support duration |
| Severe haemorrage | through short term mechanical circulatory support weaning, an average of 6 days | proportion of patients with severe haemorrage (massive haemorrhage according to SFAR or use of Novoseven or rescue surgery for bleeding) |
| Extra Corporeal Membrane Oxygenation circuit clotting | through short term mechanical circulatory support weaning, an average of 6 days | proportion of patients in which Extra Corporeal Membrane Oxygenation circuit clotting occured |
| Sepsis | up to intensive care unit discharge, an average of 15 days | proportion of patients in which sepsis occured |
Countries
France
Outcome results
None listed