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

Mieritz, Hanne Beck ; Povlsen, Amalie Ling ; Linde, Louise ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2024

In: Shock Vol. 61, No. 2 ( 2024-2), p. 209-214

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In: Shock, Ovid Technologies (Wolters Kluwer Health), Vol. 61, No. 2 ( 2024-2), p. 209-214

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.

Type of Medium: Online Resource

ISSN: 1073-2322

URL: Article

DOI: 10.1097/SHK.0000000000002272

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2024

detail.hit.zdb_id: 2011863-6

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2

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Insights Into the Pathophysiology of Unstable Coronary Artery Disease

Kristensen, Steen Dalby ; Ravn, Hanne Berg ; Falk, Erling

Elsevier BV ; 1997

In: The American Journal of Cardiology Vol. 80, No. 5 ( 1997-9), p. 5E-9E

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In: The American Journal of Cardiology, Elsevier BV, Vol. 80, No. 5 ( 1997-9), p. 5E-9E

Type of Medium: Online Resource

ISSN: 0002-9149

URL: Article

DOI: 10.1016/S0002-9149(97)00482-7

RVK:

XA 18500

Language: English

Publisher: Elsevier BV

Publication Date: 1997

detail.hit.zdb_id: 2019595-3

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3

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Magnesium Inhibits Platelet Activity - An In Vitro Study

Ravn, Hanne Berg ; Vissinger, Henrik ; Dalby Kristensen, Steen ; [et al.]

Georg Thieme Verlag KG ; 1996

In: Thrombosis and Haemostasis Vol. 76, No. 01 ( 1996), p. 088-093

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In: Thrombosis and Haemostasis, Georg Thieme Verlag KG, Vol. 76, No. 01 ( 1996), p. 088-093

Abstract: The in vitro effect of magnesium (Mg) on platelet aggregation and platelet release function was evaluated in healthy volunteers. Platelet aggregation was induced with collagen, ADP, or thrombin after incubation of the sample with saline or increasing concentrations of magnesium sulphate (MgSO4) (0.5-8.0 mM). Mg showed a dose-dependent inhibition of platelet aggregation in whole blood, platelet rich plasma and washed platelets. An antiaggregatory effect was also present with low Mg concentrations. Statistically significant inhibition of the mean aggregation response was obtained in 83% of the different media and agonists tested following the addition of 1.0 mM Mg. The remaining 17% were significantly inhibited with the addition of 2.0 mM Mg. The platelet synthesis of thromboxane A2 and release of beta-thrombo-globulin were also inhibited by Mg, in a dose-dependent manner. In order to evaluate if any of these effects were modified by conventional antithrombotic treatment with low-dose acetylsalicylic acid (ASA), volunteers were asked to meet on two consecutive days. On day 2 the participants were given 300 mg ASA orally, one hour prior to blood sampling. The Mg mediated effects were present independent of this pretreatment with ASA. Following stimulation with collagen a synergistic effect of Mg and ASA was demonstrated on platelet aggregation. The platelet inhibiting effect demonstrated in this study may in part explain the beneficial effect of Mg infusion in some patients with acute myocardial infarction. The effect of Mg infusion, given alone or administered simultaneously with ASA, should also be evaluated in other arterial thrombotic disease states.

Type of Medium: Online Resource

ISSN: 0340-6245 , 2567-689X

URL: Article

DOI: 10.1055/s-0038-1650528

Language: English

Publisher: Georg Thieme Verlag KG

Publication Date: 1996

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4

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Plasma Concentration of Biomarkers Reflecting Endothelial Cell- and Glycocalyx Damage are Increased in Patients With Suspected ST-Elevation Myocardial Infarction Complicated by Cardiogenic Shock

Frydland, Martin ; Ostrowski, Sisse Rye ; Møller, Jacob Eifer ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2018

In: Shock Vol. 50, No. 5 ( 2018-11), p. 538-544

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In: Shock, Ovid Technologies (Wolters Kluwer Health), Vol. 50, No. 5 ( 2018-11), p. 538-544

Abstract: Mortality in ST-elevation myocardial infarction (STEMI) patients developing cardiogenic shock (CS) during hospitalization is high. Catecholamines, ischemia, and inflammation (parameters present in CS) affect the endothelium. We hypothesized that plasma level of biomarkers reflecting endothelial damage would be associated with CS and mortality. Methods: In 96% of 1467 consecutive patients with suspected STEMI, biomarkers reflecting endothelial cell- (soluble thrombomodulin, sTM) and glycocalyx- (syndecan-1) damage were measured on admission. Patients were stratified by CS development or not. CS-Patients were substratified by CS on admission (admission-CS), CS developed in the catheterization laboratory (cath. lab.-CS), or late CS. Results: STEMI patients with admission-CS (n = 85) and cath.lab.-CS (n = 25) had higher levels of sTM and syndecan-1 compared with no-CS patients (n = 1,299). Late CS-patients (n = 58) had higher levels of sTM (median (25th; 75th percentile) 8.8 (7.0; 11.6) vs. 7.4 (6.0; 9.0) ng/mL, P = 0.0004) but not Syndecan-1 ( P = 0.26) compared with no-CS patients. sTM was, however, not independently associated with late CS development (OR (95% CI) 1.07 (0.99–1.16), P = 0.09). Patients with the highest level of sTM and syndecan-1 had the highest 30-day mortality ( P logrank 〈 0.0001). However, neither sTM nor Syndecan-1 was independently associated with 30-day mortality (HR (95% CI) sTM: 1.06 (0.996–1.12), P = 0.07; Syndecan-1: 1.04 (0.99–1.08), P = 0.12). Conclusion: Patients with suspected STEMI patients and admission-CS/cath.lab.-CS had elevated admission levels of sTM and Syndecan-1 compared with no CS patients. Patients developing late CS had higher sTM plasma concentration compared with patients without shock. However, the biomarker levels were not independently associated with late CS and mortality.

Type of Medium: Online Resource

ISSN: 1073-2322 , 1540-0514

URL: Article

DOI: 10.1097/SHK.0000000000001123

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2018

detail.hit.zdb_id: 2011863-6

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5

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Blood Pressure and Oxygen Targets on Kidney Injury After Cardiac Arrest

Rasmussen, Sebastian Buhl ; Jeppesen, Karoline Korsholm ; Kjaergaard, Jesper ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2023

In: Circulation

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In: Circulation, Ovid Technologies (Wolters Kluwer Health)

Abstract: Acute kidney injury (AKI) represents a common and serious complication to out-of-hospital cardiac arrest. The importance of post-resuscitation care targets for blood pressure and oxygenation for the development of AKI is unknown. METHODS: This is a substudy of a randomized 2-by-2 factorial trial, in which 789 comatose adult patients who had out-of-hospital cardiac arrest with presumed cardiac cause and sustained return of spontaneous circulation were randomly assigned to a target mean arterial blood pressure of either 63 or 77 mm Hg. Patients were simultaneously randomly assigned to either a restrictive oxygen target of a partial pressure of arterial oxygen (Pa o 2 ) of 9 to 10 kPa or a liberal oxygenation target of a Pa o 2 of 13 to 14 kPa. The primary outcome for this study was AKI according to KDIGO (Kidney Disease: Improving Global Outcomes) classification in patients surviving at least 48 hours (N=759). Adjusted logistic regression was performed for patients allocated to high blood pressure and liberal oxygen target as reference. RESULTS: The main population characteristics at admission were: age, 64 (54–73) years; 80% male; 90% shockable rhythm; and time to return of spontaneous circulation, 18 (12–26) minutes. Patients allocated to a low blood pressure and liberal oxygen target had an increased risk of developing AKI compared with patients with high blood pressure and liberal oxygen target (84/193 [44%] versus 56/187 [30%] ; adjusted odds ratio, 1.87 [95% CI, 1.21–2.89]). Multinomial logistic regression revealed that the increased risk of AKI was only related to mild-stage AKI (KDIGO stage 1). There was no difference in risk of AKI in the other groups. Plasma creatinine remained high during hospitalization in the low blood pressure and liberal oxygen target group but did not differ between groups at 6- and 12-month follow-up. CONCLUSIONS: In comatose patients who had been resuscitated after out-of-hospital cardiac arrest, patients allocated to a combination of a low mean arterial blood pressure and a liberal oxygen target had a significantly increased risk of mild-stage AKI. No difference was found in terms of more severe AKI stages or other kidney-related adverse outcomes, and creatinine had normalized at 1 year after discharge. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03141099.

Type of Medium: Online Resource

ISSN: 0009-7322 , 1524-4539

URL: Article

DOI: 10.1161/CIRCULATIONAHA.123.066012

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2023

detail.hit.zdb_id: 1466401-X

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Failure of remote ischemic preconditioning to reduce the risk of postoperative acute kidney injury in children undergoing operation for complex congenital heart disease: A randomized single-center study

Pedersen, Kirsten Rønholt ; Ravn, Hanne Berg ; Povlsen, Johan Vestergaard ; [et al.]

Elsevier BV ; 2012

In: The Journal of Thoracic and Cardiovascular Surgery Vol. 143, No. 3 ( 2012-03), p. 576-583

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In: The Journal of Thoracic and Cardiovascular Surgery, Elsevier BV, Vol. 143, No. 3 ( 2012-03), p. 576-583

Type of Medium: Online Resource

ISSN: 0022-5223

URL: Article

DOI: 10.1016/j.jtcvs.2011.08.044

Language: English

Publisher: Elsevier BV

Publication Date: 2012

detail.hit.zdb_id: 2007600-9

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Outcome After Surgery for Acute Aortic Dissection: Influence of Preoperative Antiplatelet Therapy on Prognosis

Chemtob, Raphaelle Avigael ; Moeller-Soerensen, Hasse ; Holmvang, Lene ; [et al.]

Elsevier BV ; 2017

In: Journal of Cardiothoracic and Vascular Anesthesia Vol. 31, No. 2 ( 2017-04), p. 569-574

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In: Journal of Cardiothoracic and Vascular Anesthesia, Elsevier BV, Vol. 31, No. 2 ( 2017-04), p. 569-574

Type of Medium: Online Resource

ISSN: 1053-0770

URL: Article

DOI: 10.1053/j.jvca.2016.10.007

Language: English

Publisher: Elsevier BV

Publication Date: 2017

detail.hit.zdb_id: 2043630-0

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8

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Risk factors of late cardiogenic shock and mortality in ST-segment elevation myocardial infarction patients

Obling, Laust ; Frydland, Martin ; Hansen, Rikke ; [et al.]

Oxford University Press (OUP) ; 2018

In: European Heart Journal: Acute Cardiovascular Care Vol. 7, No. 1 ( 2018-02), p. 7-15

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In: European Heart Journal: Acute Cardiovascular Care, Oxford University Press (OUP), Vol. 7, No. 1 ( 2018-02), p. 7-15

Abstract: The incidence of cardiogenic shock (CS) in patients with ST-segment elevation myocardial infarction (STEMI) is as high as 10%. The majority of patients are thought to develop CS after admission (late CS), but the incidence in a contemporary STEMI cohort admitted for primary percutaneous intervention remains unknown. Aim: The aim of this study was to assess the incidence and time of CS onset in patients with suspected STEMI admitted in two high-volume tertiary heart centres and to assess the variables associated with the development of late CS. Methods: We included consecutive patients admitted for acute coronary angiography with suspected STEMI in a 1-year period. Cardiogenic shock was based on clinical criteria and subdivided into patients with shock on admission, patients developing shock during catheterisation and patients developing shock later during hospitalisation. Follow-up for all-cause mortality was done using registries. Results: A total of 2247 patients with suspected STEMI were included, whereof 225 (10%) developed CS. The majority (56%) had CS on admission, 16% developed CS in the catheterisation laboratory and 28% developed late CS. Thirty-day mortality was 3.1% versus 47% in non-CS versus CS patients ( p logrank 〈 0.0001). Age, stroke, time from symptom onset to intervention, anterior STEMI, heart rate/systolic blood pressure ratio and being comatose after resuscitation from cardiac arrest were independently associated with the development of late CS. Conclusion: In this study, 10% of patients admitted with suspected STEMI for acute coronary angiography presented with or developed CS. Most were in shock on admission. Irrespective of the timing of shock, mortality was high.

Type of Medium: Online Resource

ISSN: 2048-8726 , 2048-8734

URL: Article

DOI: 10.1177/2048872617706503

Language: English

Publisher: Oxford University Press (OUP)

Publication Date: 2018

detail.hit.zdb_id: 2663340-1

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Data on association between QRS duration on prehospital ECG and mortality in patients with confirmed STEMI

Hansen, Rikke ; Frydland, Martin ; Møller-Helgestad, Ole Kristian ; [et al.]

Elsevier BV ; 2017

In: Data in Brief Vol. 15 ( 2017-12), p. 12-17

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In: Data in Brief, Elsevier BV, Vol. 15 ( 2017-12), p. 12-17

Type of Medium: Online Resource

ISSN: 2352-3409

URL: Article

DOI: 10.1016/j.dib.2017.08.051

Language: English

Publisher: Elsevier BV

Publication Date: 2017

detail.hit.zdb_id: 2786545-9

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Unloading using Impella CP during profound cardiogenic shock caused by left ventricular failure in a large animal model: impact on the right ventricle

Josiassen, Jakob ; Helgestad, Ole Kristian Lerche ; Udesen, Nanne Louise Junker ; [et al.]

Springer Science and Business Media LLC ; 2020

In: Intensive Care Medicine Experimental Vol. 8, No. 1 ( 2020-12)

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In: Intensive Care Medicine Experimental, Springer Science and Business Media LLC, Vol. 8, No. 1 ( 2020-12)

Abstract: This study aimed to assess right ventricular (RV) function during cardiogenic shock due to acute left ventricular (LV) failure, including during LV unloading with Impella CP and an added moderate dose of norepinephrine. Methods Cardiogenic shock was induced by injecting microspheres in the left main coronary artery in 18 adult Danish Landrace pigs. Conductance catheters were placed in both ventricles and pressure-volume loops were recorded simultaneously. Results Cardiogenic shock due to LV failure also impaired RV performance, which was partially restored during haemodynamic support with Impella CP, as demonstrated by changes in the ventriculo-arterial coupling (Ea/Ees ratio) (baseline (median [Q1;Q3]) 1.2 [1.1;1.6] ), cardiogenic shock (3.0 [2.4;4.5]), Impella CP (2.1 [1.3;2.7] ) (p Baseline vs CS 〈 0.0001, p CS vs Impella = 0.001)). Impella CP support also improved RV stroke work (SW) (cardiogenic shock 333 [263;530] vs Impella CP (830 [717;1121] ) ( p 〈 0.001). Moderate norepinephrine infusion concomitant with Impella CP further improved RV SW (Impella CP (818 [751;1065]) vs Impella CP+moderate norepinephrine (1231 [1142;1335] ) ( p = 0.01)) but at the expense of an increase in LV SW (Impella CP (858 [555;1392]) vs Impella CP+moderate norepinephrine (2101 [1024;2613] ) ( p = 0.04)). Conclusions The Impella CP provided efficient LV unloading, improved RV function, and end-organ perfusion. Moderate doses of norepinephrine during Impella support further improved RV function, but at the expense of an increase in SW of the failing LV.

Type of Medium: Online Resource

ISSN: 2197-425X

URL: Article

DOI: 10.1186/s40635-020-00326-y

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2020

detail.hit.zdb_id: 2740385-3

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