Rationale: Identification of cardiogenic shock severity is a critical step to adapt the management level upon admission. Peripheral tissue perfusion signs, simple and reliable markers of tissue hypoperfusion have never been extensively assessed during cardiogenic shock. Objectives: To assess the correlation of capillary refill time values with 90-day mortality in cardiogenic shock patients or the need for venoarterial extracorporeal membrane oxygenation (VA-ECMO) support. Also to assess the correlation between capillary refill time and hemodynamic parameters. Methods: All consecutive patients with cardiogenic shock admitted to the intensive care unit of two tertiary teaching hospitals were included in a prospective observational study. Macro-hemodynamic parameters (such as heart rate, blood pressure, left ventricular ejection fraction, and cardiac index) and peripheral tissue perfusion signs, such as capillary refill time on the index fingertip, mottling, and Pv-aCO2 (the difference between partial pressure of CO2 between venous and arterial blood) were recorded at inclusion (0 hour), 6 hours, 12 hours, 24 hours, and 48 hours. The composite primary endpoint was the association between 90-day mortality or the need for VA-ECMO support. Measurements and Main Results: A total of 61 patients were included; at inclusion, simplified acute physiology score II was 64 (52-77) points. The primary endpoint was met by 42% of patients. Capillary refill time values were significantly higher at all time points in nonsurvivors or patients needing VA-ECMO support. In univariate analysis, capillary refill time > 3 seconds at inclusion was associated with 90-day all-cause mortality or VA-ECMO support (hazard ratio, 12.38; 95% confidence interval, 2.91-52.71). Capillary refill time at inclusion was poorly associated with macrocirculatory parameters but significantly correlated with microcirculatory parameters. Further, capillary refill time added incremental value to Cardshock score, with an AUC combination at 0.93. Conclusions: In patients with cardiogenic shock admitted to the ICU, our preliminary data suggest that a prolonged capillary refill time >3 seconds was associated with an early prediction of 90-day mortality or the need for VA-ECMO support.

中文翻译：

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早期毛细血管再充盈时间测量对心源性休克结果的影响：一项观察性、前瞻性多中心研究。

理由：确定心源性休克严重程度是调整入院管理水平的关键步骤。在心源性休克期间，从未广泛评估外周组织灌注征象、简单可靠的组织低灌注标志物。目的：评估毛细血管再充盈时间值与心源性休克患者 90 天死亡率或是否需要静脉动脉体外膜肺氧合 (VA-ECMO) 支持的相关性。还要评估毛细血管再充盈时间和血液动力学参数之间的相关性。方法：所有入住两家三级教学医院重症监护病房的连续心源性休克患者被纳入一项前瞻性观察研究。宏观血流动力学参数（如心率、血压、左心室射血分数、和心脏指数）和外周组织灌注征象，如食指毛细血管再充盈时间、斑点和 Pv-aCO2（静脉血和动脉血 CO2 分压之间的差异）在纳入（0 小时）时记录，6小时、12 小时、24 小时和 48 小时。复合主要终点是 90 天死亡率与 VA-ECMO 支持需求之间的关联。测量和主要结果：共包括 61 名患者；纳入时，简化的急性生理评分 II 为 64 (52-77) 分。42% 的患者达到了主要终点。非幸存者或需要 VA-ECMO 支持的患者的毛细血管再充盈时间值在所有时间点都显着更高。在单变量分析中，毛细血管再充盈时间 > 纳入时 3 秒与 90 天全因死亡率或 VA-ECMO 支持相关（风险比，12.38；95% 置信区间，2.91-52.71）。纳入时的毛细血管再充盈时间与大循环参数相关性较差，但与微循环参数显着相关。此外，毛细血管再充盈时间增加了 Cardshock 评分的增量值，AUC 组合为 0.93。结论：在入住 ICU 的心源性休克患者中，我们的初步数据表明，毛细血管再充盈时间延长 > 3 秒与 90 天死亡率的早期预测或 VA-ECMO 支持需求相关。纳入时的毛细血管再充盈时间与大循环参数相关性较差，但与微循环参数显着相关。此外，毛细血管再充盈时间增加了 Cardshock 评分的增量值，AUC 组合为 0.93。结论：在入住 ICU 的心源性休克患者中，我们的初步数据表明，毛细血管再充盈时间延长 > 3 秒与 90 天死亡率的早期预测或 VA-ECMO 支持需求相关。纳入时的毛细血管再充盈时间与大循环参数相关性较差，但与微循环参数显着相关。此外，毛细血管再充盈时间增加了 Cardshock 评分的增量值，AUC 组合为 0.93。结论：在入住 ICU 的心源性休克患者中，我们的初步数据表明，毛细血管再充盈时间延长 > 3 秒与 90 天死亡率的早期预测或 VA-ECMO 支持需求相关。