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Medicina
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Cardiogenic Shock in Emergency Medicine: Clinical Management and Outcomes
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Cardiogenic Shock in Emergency Medicine: Clinical Management and Outcomes

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (31 May 2024) | Viewed by 4480

Special Issue Editors

Dr. Alberto Somaschini

E-Mail Website
Guest Editor
Cardiac Intensive Care Unit, Division of Cardiology — San Paolo Hospital, 17100 Savona, Italy
Interests: intensive care medicine; cardiogenic shock; cardiorenal syndrome; acute inflammation biomarkers
Dr. Stefano Cornara

E-Mail Website
Guest Editor
Arrhythmia Unit, Division of Cardiology — San Paolo Hospital, 17100 Savona, Italy
Interests: cardiogenic shock; arrhythmias; catheter ablation; acute myocardial infarction; acute inflammatory biomarkers

Special Issue Information

Dear Colleagues,

Cardiogenic shock (CS) remains one of the leading causes of mortality in patients with cardiac diseases. The most frequent trigger of CS is ventricular failure due to myocardial infarction, with mortality rates approaching 50%. Nevertheless, other conditions can be complicated by CS, such as acute myocarditis, arrhythmias, and advanced chronic heart failure.

In this challenging scenario, every effort is needed in order to improve patients’ survival. Historically, inotropes and vasopressors have been the drugs of choice to achieve hemodynamic stabilization and prevent multiorgan system disfunction. Unfortunately, their use may induce several side effects including cardiotoxicity.

Temporary mechanical circulatory support (MCS) devices such as intra-aortic balloon pump, Impella, Tandem heart, and ECMO represent another available therapeutic option to improve organ perfusion and prognosis, limiting the toxicity of catecholamines. Nonetheless, the current available evidence is poor, and thus, it is difficult to draw definitive conclusions regarding the choice of the right device, as well as the safety and timing of implants. 

Moreover, there are many factors, such as revascularization strategies, supportive therapies during intensive care unit stay (i.e., ventilation, nutrition, fluid management), and implementation of local cardiogenic shock networks, which could play a key role in improving prognosis.

The present Special Issue aims to offer new insights into the clinical management and the outcomes of patients affected by CS, in order to deepen the knowledge of this challenging condition. In addition, papers focusing on intriguing cases, brief reports, and reviews are encouraged.

Dr. Alberto Somaschini
Dr. Stefano Cornara
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • cardiogenic shock
  • mechanical circulatory support devices
  • inotropes
  • vasopressors
  • arrhythmias
  • nutritional support

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Published Papers (2 papers)

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Research

12 pages, 690 KiB  
Article
Beneficial Effects of IABP in Anterior Myocardial Infarction Complicated by Cardiogenic Shock
by Alberto Somaschini, Stefano Cornara, Sergio Leonardi, Andrea Demarchi, Alessandro Mandurino-Mirizzi, Federico Fortuni, Marco Ferlini, Gabriele Crimi, Rita Camporotondo, Massimiliano Gnecchi, Luigi Oltrona Visconti, Stefano De Servi and Gaetano Maria De Ferrari
Medicina 2023, 59(10), 1806; https://doi.org/10.3390/medicina59101806 - 11 Oct 2023
Cited by 2 | Viewed by 2185
Abstract
Background and Objectives. Recent guidelines have downgraded the routine use of the intra-aortic balloon pump (IABP) in patients with cardiogenic shock (CS) due to ST-elevation myocardial infarction (STEMI). Despite this, its use in clinical practice remains high. The aim of this study [...] Read more.
Background and Objectives. Recent guidelines have downgraded the routine use of the intra-aortic balloon pump (IABP) in patients with cardiogenic shock (CS) due to ST-elevation myocardial infarction (STEMI). Despite this, its use in clinical practice remains high. The aim of this study was to evaluate the prognostic impact of the IABP in patients with STEMI complicated by CS undergoing primary PCI (pPCI), focusing on patients with anterior MI in whom a major benefit has been previously hypothesized. Materials and Methods. We enrolled 2958 consecutive patients undergoing pPCI for STEMI in our department from 2005 to 2018. Propensity score matching and mortality analysis were performed. Results. CS occurred in 246 patients (8.3%); among these patients, 145 (60%) had anterior AMI. In the propensity-matched analysis, the use of the IABP was associated with a lower 30-day mortality (39.3% vs. 60.9%, p = 0.032) in the subgroup of patients with anterior STEMI. Conversely, in the whole group of CS patients and in the subgroup of patients with non-anterior STEMI, IABP use did not have a significant impact on mortality. Conclusions. The use of the IABP in cases of STEMI complicated by CS was found to improve survival in patients with anterior infarction. Prospective studies are needed before abandoning or markedly limiting the use of the IABP in this clinical setting. Full article
(This article belongs to the Special Issue Cardiogenic Shock in Emergency Medicine: Clinical Management and Outcomes)
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12 pages, 1076 KiB  
Article
Sex-Related Differences in Short-Term Prognosis in Patients with Acute Myocardial Infarction-Related Cardiogenic Shock Receiving Impella Support in Japan: From the J-PVAD Registry
by Makiko Nakamura, Teruhiko Imamura, Hiroshi Ueno, Koichiro Kinugawa and J-PVAD Investigators
Medicina 2023, 59(7), 1208; https://doi.org/10.3390/medicina59071208 - 27 Jun 2023
Cited by 4 | Viewed by 1882
Abstract
Background and Objectives: Sex-specific outcome in patients with acute myocardial infarction-related cardiogenic shock (AMI-CS) receiving temporary mechanical circulatory support remains controversial. Materials and Methods: Patients with AMI-CS who received Impella support were prospectively enrolled in the Japanese registry for Percutaneous Ventricular Assist Device. [...] Read more.
Background and Objectives: Sex-specific outcome in patients with acute myocardial infarction-related cardiogenic shock (AMI-CS) receiving temporary mechanical circulatory support remains controversial. Materials and Methods: Patients with AMI-CS who received Impella support were prospectively enrolled in the Japanese registry for Percutaneous Ventricular Assist Device. Patients enrolled between January 2021 and December 2022 were considered to be eligible. Patients with out-of-hospital cardiac arrest and those without revascularization were excluded. The sex disparity in the 30-day survival after the initiation of Impella support was evaluated. Results: A total of 924 patients (median age 73 years; 21% female) were included. Female patients were older and had a smaller physiques than male patients (p < 0.05 for both). Female sex was significantly associated with a higher 30-day mortality after adjustment for four other potential confounders with a hazard ratio of 1.365 (95% confidence interval 1.026–1.816, p = 0.0324). In the female cohort, patients who received Impella prior to revascularization (N = 138) had a greater survival rate compared to those who received Impella after revascularization (68.1% versus 44.8%, p = 0.0015). Conclusions: Among the patients with AMI-CS who received Impella support and underwent revascularization, female sex was independently associated with a lower 30-day survival. For female patients, early initiation of Impella support prior to revascularization may improve their clinical outcomes. Full article
(This article belongs to the Special Issue Cardiogenic Shock in Emergency Medicine: Clinical Management and Outcomes)
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