DIFFERENCES IN MANAGEMENT AND PROGNOSTICATION OF CARDIOGENIC SHOCK PATIENTS IN THE PRESENCE AND ABSENCE OF OUT-OF-HOSPITAL CARDIAC ARREST.

Autor:	Mieritz HB; Department of Cardiothoracic Anesthesia, Odense University Hospital, Odense, Denmark., Povlsen AL; Department of Cardiothoracic Anesthesia, Odense University Hospital, Odense, Denmark., Linde L; Department of Cardiology, Odense University Hospital, Odense, Denmark., Beske RP; Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark., Helgestad OKL; Department of Cardiology, Odense University Hospital, Odense, Denmark., Josiassen J; Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark., Hassager C; Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark., Schmidt H; Department of Cardiothoracic Anesthesia, Odense University Hospital, Odense, Denmark., Jensen LO, Holmvang L; Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark., Møller JE, Ravn HB
Jazyk:	angličtina
Zdroj:	Shock (Augusta, Ga.) [Shock] 2024 Feb 01; Vol. 61 (2), pp. 209-214. Date of Electronic Publication: 2023 Nov 22.
DOI:	10.1097/SHK.0000000000002272
Abstrakt:	Abstract: Background: The clinical spectrum of acute myocardial infarction complicated by cardiogenic shock (AMICS) varies. Out-of-hospital cardiac arrest (OHCA) can be the first sign of cardiac failure, whereas others present with various degrees of hemodynamic instability (non-OHCA). The aim of the present study was to explore differences in prehospital management and characteristics of survivors and nonsurvivors in AMICS patients with OHCA or non-OHCA. Methods: Data analysis was based on patient data from the RETROSHOCK cohort comprising consecutive AMICS patients admitted to two tertiary cardiac centers between 2010 and 2017. Results: 1,716 AMICS patients were included and 42% presented with OHCA. Mortality in OHCA patients was 47% versus 57% in the non-OHCA group. Almost all OHCA patients were intubated before admission (96%). In the non-OHCA group, prehospital intubation (25%) was associated with a better survival ( P < 0.001). Lactate level on admission demonstrated a linear relationship with mortality in OHCA patients. In non-OHCA, probability of death was higher for any given lactate level <12 mmol/L compared with OHCA. However, a lactate level >7 mmol/L in non-OHCA did not increase mortality odds any further. Conclusion: Mortality was almost doubled for any admission lactate level up to 7 mmol/L in non-OHCA patients. Above this level, mortality remained unchanged in non-OHCA patients but continued to increase in OHCA patients. Prehospital intubation was performed in almost all OHCA patients but only in one of four patients without OHCA. Early intubation in non-OHCA patients was associated with a better outcome. Competing Interests: Dr Christian Hassager has received research grants from Lundbeck Foundation (R186-2015-2132), Novo Nordisk Foundation (NNF20OC0064043), and the Danish Heart Foundation (21-R151-A10091-22200). Dr Jacob Eifer Møller has received an institutional research grant from Abiomed and Novo Nordic Foundation. Speakers' fees were received from Abbott, Abiomed, and Boehringer Ingelheim. The remaining authors have no disclosures and report no conflicts of interest. (Copyright © 2023 by the Shock Society.)
Databáze:	MEDLINE
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