当前位置: X-MOL 学术J. Am. Coll. Cardiol. › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
Management and Outcomes of Cardiogenic Shock in Cardiac ICUs With Versus Without Shock Teams
Journal of the American College of Cardiology ( IF 24.0 ) Pub Date : 2021-09-20 , DOI: 10.1016/j.jacc.2021.07.044
Alexander I Papolos 1 , Benjamin B Kenigsberg 1 , David D Berg 2 , Carlos L Alviar 3 , Erin Bohula 2 , James A Burke 4 , Anthony P Carnicelli 5 , Sunit-Preet Chaudhry 6 , Stavros Drakos 7 , Daniel A Gerber 8 , Jianping Guo 2 , James M Horowitz 3 , Jason N Katz 5 , Ellen C Keeley 9 , Thomas S Metkus 10 , Jose Nativi-Nicolau 7 , Jeffrey R Snell 11 , Shashank S Sinha 12 , Wayne J Tymchak 13 , Sean Van Diepen 13 , David A Morrow 2 , Christopher F Barnett 1 ,
Affiliation  

Background

Single-center studies suggest that implementation of multidisciplinary cardiogenic shock (CS) teams is associated with improved CS survival.

Objectives

The aim was to characterize practice patterns and outcomes in the management of CS across multiple centers with versus without shock teams.

Methods

The Critical Care Cardiology Trials Network is a multicenter network of cardiac intensive care units (CICUs) in North America. All consecutive medical admissions to each CICU (n = 24) were captured during annual 2-month collection periods (2017-2019; n = 6,872). Shock management and CICU mortality among centers with versus without shock teams were compared using inverse probability weighting.

Results

Ten of the 24 centers had shock teams. Among 1,242 CS admissions, 44% were at shock team centers. The groups were well-balanced with respect to demographics, shock etiology, Sequential Organ Failure Assessment score, biochemical markers of end organ dysfunction, and invasive hemodynamics. Centers with shock teams used more pulmonary artery catheters (60% vs 49%; adjusted odds ratio [OR]: 1.86; 95% CI: 1.47-2.35; P < 0.001), less overall mechanical circulatory support (MCS) (35% vs 43%; adjusted OR: 0.74; 95% CI: 0.59-0.95; P = 0.016), and more advanced types of MCS (53% vs 43% of all MCS; adjusted OR: 1.73; 95% CI: 1.19-2.51; P = 0.005) rather than intra-aortic balloon pumps. The presence of a shock team was independently associated with lower CICU mortality (23% vs 29%; adjusted OR: 0.72; 95% CI: 0.55-0.94; P = 0.016).

Conclusions

In this multicenter observational study, centers with shock teams were more likely to obtain invasive hemodynamics, use advanced types of MCS, and have lower risk-adjusted mortality. A standardized multidisciplinary shock team approach may improve outcomes in CS.



中文翻译:

有与没有电击小组的心脏 ICU 中心源性休克的管理和结果

背景

单中心研究表明,多学科心源性休克 (CS) 团队的实施与 CS 生存率的提高有关。

目标

目的是表征跨多个中心的 CS 管理的实践模式和结果,有与没有冲击团队。

方法

重症监护心脏病学试验网络是北美心脏重症监护病房 (CICU) 的多中心网络。在每年 2 个月的收集期间(2017-2019 年;n = 6,872)收集到每个 CICU 的所有连续医疗入院(n = 24)。使用逆概率加权比较了有与没有电击团队的中心的电击管理和 CICU 死亡率。

结果

24 个中锋中有 10 个有突击队。在 1,242 名 CS 录取中,44% 来自休克团队中心。各组在人口统计学、休克病因、顺序器官衰竭评估评分、终末器官功能障碍的生化标志物和侵入性血流动力学方面平衡良好。有电击团队的中心使用更多的肺动脉导管(60% 对 49%;调整后的优势比 [OR]:1.86;95% CI:1.47-2.35;P  < 0.001),较少的整体机械循环支持 (MCS)(35% 对43%;调整后 OR:0.74;95% CI:0.59-0.95;P  = 0.016),以及更高级的 MCS(53% 对所有 MCS 的 43%;调整后 OR:1.73;95% CI:1.19-2.51; = 0.005) 而不是主动脉内球囊泵。休克团队的存在与较低的 CICU 死亡率独立相关(23% 对 29%;调整后的 OR:0.72;95% CI:0.55-0.94;P  = 0.016)。

结论

在这项多中心观察性研究中,有休克团队的中心更有可能获得侵入性血流动力学,使用先进的 MCS 类型,并具有较低的风险调整死亡率。标准化的多学科冲击团队方法可能会改善 CS 的结果。

更新日期:2021-09-21
down
wechat
bug