310 research outputs found
Timing and treatment strategies according to SCAI classification in cardiogenic shock
No full text: In patients with cardiogenic shock (CS), particularly those with acute myocardial infarction (AMI), evidence suggests that timely diagnosis and treatment interventions are critical in the prevention of haemo-metabolic compromise. Temporary mechanical circulatory support (tMCS) has shown potential in facilitating revascularization and recovery of patients with acute myocardial infarction cardiogenic shock (AMI-CS). Timing of treatment strategies for CS patients needs to be optimized for use of tMCS devices that are applicable to this heterogeneous patient population. Here, the latest evidence as well as the gaps in knowledge surrounding the role of time in the management of patients with CS is summarized
Haemodynamic, oxygenation, and ventilation targets after cardiac arrest: the current ABC of post-cardiac arrest intensive care
No full textPatients remaining in coma after having been resuscitated from out-of-hospital cardiac arrest (OHCA) frequently require intensive care. These patients are usually managed by a guideline-recommended, goal-directed approach to support and maintain organ function.1 Since hypoxic brain injury is the leading cause of death in these patients,2 neuroprotective strategies and interventions have been implemented and investigated. In fact, post-resuscitation care has come to represent a bundle of strategies and goal-directed interventions administered over the first 2–5 days following cardiac arrest.1While research in post-cardiac arrest care of OHCA patients has been dominated by targeted temperature management (TTM) and neurological prognostication,1 the other aspects of optimizing therapy have received less scientific attention. Targeted temperature management was originally implemented after two randomized clinical trials were published in 2002, reporting the clinical benefits of lowering body temperature to 33°C for 12–24 h.3,4 These trials were unspecific in terms of guiding the other aspects of post-cardiac arrest care in the intensive care setting. Later trials in TTM have been pragmatic, and the results have questioned the benefits of mild-to-moderate hypothermia in the immediate post-resuscitation phase.5,6Although ischaemic heart disease is the underlying cause of cardiac arrest in many OHCA patients , an initial diagnostic approach of immediate coronary angiography in patients suspected with an acute myocardial infarction ST segment myocardial infarction has also been challenged.7Therefore, contemporary patient management is largely based on intensive supportive care and most centres have standardized protocols for supporting airway, breathing, and circulation for patients remaining in coma after cardiac arrest. Both American and European guidelines have provided recommendations on treatment targets in post-resuscitation care but have made it clear that evidence is less.1,8This review seeks to provide an overview of current evidence and guidelines on goals for intensive care for the initial days of post-cardiac arrest. Table 1 provides an overview of the recent randomized trials conducted
Independence of restrictive filling pattern and LV ejection fraction with mortality in heart failure: an individual patient meta-analysis. Meta-analysis research group in echocardiography (MeRGE) Heart Failure Collaborators
No full textUdgivelsesdato: 2008/
Mechanical circulatory support for decompensated heart failure:the last remaining indication for intra-aortic balloon pump?
No full textContemporary use of temporary mechanical circulatory support in infarct‐related cardiogenic shock: Time to stop and reflect?
No full textThe use of temporary mechanical circulatory support (MCS) in the management of refractory cardiac arrest and acute myocardial infarction complicated by cardiogenic shock (AMICS) has changed dramatically over the last decade. While the use of intra-aortic balloon pump for AMICS in some countries has virtually ceased, the use of percutaneous micro axial flow pumps (mAFP) and venoarterial extracorporeal membrane oxygenation (VA-ECMO) has increased worldwide.1, 2 Cardiogenic shock is a syndrome defined by hypoperfusion due to cardiac failure despite adequate ventricular filling, representing a situation where the heart pivotal role to deliver oxygenated blood to the body is failing triggering a vicious circle of organ failure and systemic inflammation. This is a complex heterogeneous and haemodynamically challenging condition, not infrequently difficult to diagnose and certainly not easy to treat. In a situation with imminent or overt haemodynamic collapse due inadequate cardiac output, restoration of flow using MCS seems intuitive. In some patients MCS seems immediate lifesaving with stabilization of haemodynamics and maybe even recovery of heart function, while in others multiorgan failure continues to develop despite adequate device performance. Equipoise exists to the benefit of use of these devices, but the use continues to increase
Future for cardiogenic shock research
No full textPurpose of review To discuss future research themes and study design in cardiogenic shock. Recent findings Cardiogenic shock research faces multiple challenges, hindering progress in understanding and treating this life-threatening condition. Cardiogenic shock’s heterogeneous nature poses challenges in patient selection for clinical trials, potentially leading to variability in treatment responses and outcomes. Ethical considerations arise due to the acuity and severity of the condition, posing challenges in obtaining informed consent and conducting randomized controlled trials where time to treatment is pivotal. Summary This review discusses research in this area focusing on the importance of phenotyping patients with cardiogenic shock, based on artificial intelligence, machine learning, and unravel new molecular mechanisms using proteomics and metabolomics. Further, the future research focus in mechanical circulatory support and targeting inflammation is reviewed. Finally, newer trial designs including adaptive platform trials are discussed.</p
Danish German Cardiogenic Shock Trial - DanGer shock:Trial Design Update
No full textBACKGROUND: The main objective of the Danish German Cardiogenic Shock trial (DanGer Shock ClinicalTrials.gov Identifier: NCT01633502) is to assess the efficacy of the trans valvular axial flow device Impella CP in treating patients with AMICS shock due to STEMI undergoing emergency percutaneous coronary intervention.METHODS: This statistical analysis plan represents an overview of the statistical methods which will be used for analyzing the DanGer Shock trial.RESULTS: The primary study endpoint is death from all causes through 180 days in the intention to treat population (all randomized consented patients). The secondary endpoints comprise; composite event of the need for additional mechanical support, need for cardiac transplantation, and death of all causes whichever comes first; and days alive and out of hospital. As exploratory analyses an as treated analysis of primary endpoint will be performed. Composite safety endpoint will comprise of major bleeding, vascular complications, device malfunction, damage to the aortic valve, and significant hemolysis. The primary endpoint death rate at 180 days will be analyzed using Cox proportional hazards analysis. The result will be reported as hazard ratio and corresponding 95% confidence interval (95% CI). No imputation of missing values will be performed. Additional statistical analyses for predefined hemodynamic, metabolic, renal, hematological, and health economics substudies will be specified in separate protocols.CONCLUSION: Main analyses of the primary and secondary outcomes of the DanGer Shock trial will be conducted according to this publication.</p
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