MedStar Authors catalog › Details for: Epidemiology of Shock in Contemporary Cardiac Intensive Care Units.
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Epidemiology of Shock in Contemporary Cardiac Intensive Care Units.

by Barnett, Christopher F.
Citation: ; Circulation. Cardiovascular Quality & Outcomes. 12(3):e005618, 2019 03..Journal: Circulation. Cardiovascular quality and outcomes.Published: ; 2019; ISSN: 1941-7713.Full author list: Alviar CL; Baird-Zars VM; Barnett CF; Barsness GW; Berg DD; Bohula EA; Burke JA; Cremer PC; Cruz J; Daniels LB; DeFilippis AP; Haleem A; Hollenberg SM; Horowitz JM; Jeffrey Snell R; Katz JN; Keller N; Kontos MC; Lawler PR; Menon V; Metkus TS; Morrow DA; Ng J; Orgel R; Overgaard CB; Park JG; Phreaner N; Roswell RO; Schulman SP; Solomon MA; Ternus B; Tymchak W; van Diepen S; Vikram F.UI/PMID: 30879324.Subject(s): Aged | Time Factors | Shock, Cardiogenic/th [Therapy] | Shock, Cardiogenic/mo [Mortality] | *Shock, Cardiogenic/ep [Epidemiology] | Shock, Cardiogenic/di [Diagnosis] | Risk Factors | Risk Assessment | Registries | Prognosis | Organ Dysfunction Scores | North America/ep [Epidemiology] | Myocardial Infarction/th [Therapy] | Myocardial Infarction/mo [Mortality] | *Myocardial Infarction/ep [Epidemiology] | Myocardial Infarction/di [Diagnosis] | Middle Aged | Male | Humans | Hospital Mortality | Female | *Coronary Care UnitsInstitution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal Article | Research Support, N.I.H., Extramural | Research Support, N.I.H., IntramuralOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.1161/CIRCOUTCOMES.119.005618 (Click here) Abbreviated citation: ; Circ Cardiovasc Qual Outcomes. 12(3):e005618, 2019 03.Abstract: Background Clinical investigations of shock in cardiac intensive care units (CICUs) have primarily focused on acute myocardial infarction (AMI) complicated by cardiogenic shock (AMICS). Few studies have evaluated the full spectrum of shock in contemporary CICUs. Methods and Results The Critical Care Cardiology Trials Network is a multicenter network of advanced CICUs in North America. Anytime between September 2017 and September 2018, each center (n=16) contributed a 2-month snap-shot of all consecutive medical admissions to the CICU. Data were submitted to the central coordinating center (TIMI Study Group, Boston, MA). Shock was defined as sustained systolic blood pressure <90 mm Hg with end-organ dysfunction ascribed to the hypotension. Shock type was classified by site investigators as cardiogenic, distributive, hypovolemic, or mixed. Among 3049 CICU admissions, 677 (22%) met clinical criteria for shock. Shock type was varied, with 66% assessed as cardiogenic shock (CS), 7% as distributive, 3% as hypovolemic, 20% as mixed, and 4% as unknown. Among patients with CS (n=450), 30% had AMICS, 18% had ischemic cardiomyopathy without AMI, 28% had nonischemic cardiomyopathy, and 17% had a cardiac cause other than primary myocardial dysfunction. Patients with mixed shock had cardiovascular comorbidities similar to patients with CS. The median CICU stay was 4.0 days (interquartile range [IQR], 2.5-8.1 days) for AMICS, 4.3 days (IQR, 2.1-8.5 days) for CS not related to AMI, and 5.8 days (IQR, 2.9-10.0 days) for mixed shock versus 1.9 days (IQR, 1.0-3.6) for patients without shock ( P<0.01 for each). Median Sequential Organ Failure Assessment scores were higher in patients with mixed shock (10; IQR, 6-13) versus AMICS (8; IQR, 5-11) or CS without AMI (7; IQR, 5-11; each P<0.01). In-hospital mortality rates were 36% (95% CI, 28%-45%), 31% (95% CI, 26%-36%), and 39% (95% CI, 31%-48%) in AMICS, CS without AMI, and mixed shock, respectively. Conclusions The epidemiology of shock in contemporary advanced CICUs is varied, and AMICS now represents less than one-third of all CS. Despite advanced therapies, mortality in CS and mixed shock remains high. Investigation of management strategies and new therapies to treat shock in the CICU should take this epidemiology into account.

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