Epidemiology of Shock in Contemporary Cardiac Intensive Care Units

作者：David D. Berg, Erin A. Bohula, Sean van Diepen, Jason N. Katz, Carlos L. Alviar, Vivian M. Baird-Zars, Christopher F. Barnett, Gregory W. Barsness, James A. Burke, Paul Cremer, Jennifer Cruz, Lori B. Daniels, Andrew P. DeFilippis, Affan Haleem, Steven M. Hollenberg, James M. Horowitz, Norma Keller, Michael C. Kontos, Patrick R. Lawler, Venu Menon, Thomas S. Metkus, Jason Ng, Ryan Orgel, Christopher B. Overgaard, Jeong-Gun Park, Nicholas Phreaner, Robert O. Roswell, Steven P. Schulman, R. Jeffrey Snell, Michael A. Solomon, Bradley Ternus, Wayne Tymchak, Fnu Vikram, David A. Morrow · 发表于：Circulation Cardiovascular Quality and Outcomes · 年份：2019 · DOI：10.1161/circoutcomes.119.005618 · 被引用次数：431 · 研究领域：Mechanical Circulatory Support Devices、Cardiac Arrest and Resuscitation、Heart Failure Treatment and Management

Background Clinical investigations of shock in cardiac intensive care units (CICUs) have primarily focused on acute myocardial infarction (AMI) complicated by cardiogenic shock (AMICS). Few studies have evaluated the full spectrum of shock in contemporary CICUs. Methods and Results The Critical Care Cardiology Trials Network is a multicenter network of advanced CICUs in North America. Anytime between September 2017 and September 2018, each center (n=16) contributed a 2-month snap-shot of all consecutive medical admissions to the CICU. Data were submitted to the central coordinating center (TIMI Study Group, Boston, MA). Shock was defined as sustained systolic blood pressure <90 mm Hg with end-organ dysfunction ascribed to the hypotension. Shock type was classified by site investigators as cardiogenic, distributive, hypovolemic, or mixed. Among 3049 CICU admissions, 677 (22%) met clinical criteria for shock. Shock type was varied, with 66% assessed as cardiogenic shock (CS), 7% as distributive, 3% as hypovolemic, 20% as mixed, and 4% as unknown. Among patients with CS (n=450), 30% had AMICS, 18% had ischemic cardiomyopathy without AMI, 28% had nonischemic cardiomyopathy, and 17% had a cardiac cause other than primary myocardial dysfunction. Patients with mixed shock had cardiovascular comorbidities similar to patients with CS. The median CICU stay was 4.0 days (interquartile range [IQR], 2.5-8.1 days) for AMICS, 4.3 days (IQR, 2.1-8.5 days) for CS not related to AMI, and 5.8 d...