Acute cardiac care & resuscitationCohort study
Circulatory Support Escalation in Cardiogenic Shock: Outcomes and Predictors of Successful Escalation From an International, Multi-Center Cardiac Intensive Care Registry
- retrospective international registry
- 4 cardiac intensive care units
- consecutive patients
- multi-center
Authors' conclusion
Circulatory support escalation is prevalent in patients treated for CS. Escalation is associated with a higher risk of hospital death, complications, and transition to heart replacement therapy, consistent with the intrinsically higher risk profile and expected trajectory of escalated patients. However, outcomes may differ according to the specific escalation strategy. Resorting to escalation in younger patients, in less severe CS stages, when the right ventricular function and urinary output are still preserved, is associated with a higher chance of subsequent survival.
Study context
- Population
- Patients with cardiogenic shock (CS) treated in cardiac intensive care unitsconsecutive patients with CS, escalation required in 30%
- Participants
- 602 patients
- Exposure
- Escalation vs no escalation of circulatory support
Main finding
Hospital mortality
Adjusted odds ratio
3.42
95% CI 2.21–3.35
P < 0.001
By group
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | Escalation | No escalation | adjusted odds ratio (95% CI) | P value | |
|---|---|---|---|---|---|
| Transition to heart replacement therapies | 23% | 5% | 6.01 (3.31–11.27) | P < 0.001 | |
| 0.050.21520Adjusted odds ratio (log scale) |
- Transition to heart replacement therapies: adjusted for age, sex, chronic kidney disease, markers of CS severity on admission, CS cause, and admission source
Escalation strategies
- inotropes/vasopressors
- 36%
- intra-aortic balloon pump
- 39%
- Impella
- 14%
- venoarterial extracorporeal membrane oxygenation
- 11%
- share of escalated patients
Mediation of escalation–hospital death association by complications
- Complications mediated
- 24% (95% CI, 9%-40%)
Discharged alive among escalated patients
- Escalated patients successfully discharged alive
- 42%
Predictors of successful escalation
- Age, the Society for Cardiovascular Angiography and Intervention B to C stage at escalation, tricuspid annular plane systolic excursion at escalation, and mean urinary output ≥1 mL/kg per hour in the 6 hours preceding escalation were independently associated with successful escalation
- adjusted for sex, chronic kidney disease, and markers of CS severity on admission and at time of escalation
Original publication
Summarised from the published abstract; every number is checked against it