1. Current and future trial design in refractory cardiogenic shock.
- Author
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Arrigo, Mattia, Blet, Alice, Morley‐Smith, Andrew, Aissaoui, Nadia, Baran, David A., Bayes‐Genis, Antoni, Chioncel, Ovidiu, Desch, Steffen, Karakas, Mahir, Moller, Jacob Eifer, Poess, Janine, Price, Susanna, Zeymer, Uwe, and Mebazaa, Alexandre
- Subjects
CARDIOGENIC shock ,NON-ST elevated myocardial infarction ,MYOCARDIAL infarction - Abstract
Cardiogenic shock (CS) is a syndrome of life-threatening peripheral hypoperfusion and organ dysfunction due to primary cardiac dysfunction,[1] with relevant morbidity and high mortality rates up to 50% at 1 year.[2] Several underlying cardiac conditions may induce CS, with acute myocardial infarction accounting for about 30% of CS and other acute causes and pre-existing chronic heart disease accounting for the remaining 70%.[[3], [5]] Management is largely based on experience rather than evidence-based recommendations as few adequately designed randomized clinical trials (RCT) to guide treatment exist.[[6]] In this context, several strategies to improve research for novel CS treatments have recently been proposed.[[1], [8]] Particular attention is currently given to refractory patients with a growing number of RCTs investigating various modalities of mechanical circulatory support (MCS). In general, CS is defined as a state in which inadequate cardiac output - caused by a primary cardiac dysfunction - results in peripheral hypoperfusion.[[9]] The clinical presentation ranges from normotensive shock (i.e. signs of hypoperfusion without hypotension) to profound hypotension,[11] and from mild hypoperfusion to severe forms not responding to medical therapy. Furthermore, the underlying pathophysiology of CS is associated with different mechanisms: CS arising from a pre-existing cardiac disorder (heart failure [HF]-CS) is frequently predominated by systemic congestion followed by hypoperfusion and hypotension, while congestion is secondary to hypoperfusion and hypotension in CS caused by acute myocardial infarction (AMI-CS).[[3], [12]] Refractory CS refers to an ill-defined severity of CS not responding to standard therapies. Extracorporeal membrane oxygenation in the therapy of cardiogenic shock: results of the ECMO-CS randomized clinical trial. [Extracted from the article]
- Published
- 2023
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