Management of cardiogenic shock in acute decompensated chronic heart failure: The ALTSHOCK phase II clinical trial

Publication date: Available online 20 July 2018Source: American Heart JournalAuthor(s): Nuccia Morici, Fabrizio Oliva, Silvia Ajello, Miriam Stucchi, Alice Sacco, Manlio Gianni Cipriani, Michele De Bonis, Andrea Garascia, Maria Pia Gagliardone, Giulio Melisurgo, Claudio Francesco Russo, Carlo La Vecchia, Maria Frigerio, Federico PappalardoManagement of acute decompensated heart failure (ADHF) patients presenting with cardiogenic shock (CS) is not straightforward, as few data are available from clinical trials. Stabilization before left ventricle assist device (LVAD) or heart transplantation (HTx) is strongly advocated, as patients undergoing LVAD implant or HTx in critical status fare worse outcomes.This was a multicenter phase II study with a Simon two-stage design, including 24 consecutive patients treated with low-moderate epinephrine doses, whose refractory CS prompted implantation of intra-aortic balloon pump (IABP) which was subsequently upgraded with peripheral veno-arterial extracorporeal membrane oxygenation (VA ECMO).At admission patients had severe left ventricular dysfunction and overt CS, seven patients could be managed only with inotropic therapy, 16 patients were transitioned to IABP and one to IABP and VA-ECMO; the median duration of epinephrine therapy was 7 days (IQR: 6–15) and the median dose was 0.08 mcg/Kg/min (IQR 0.05–0.1); 21 patients (87.5%) survived at 60 days (primary outcome); among them, 13 (61.9%) underwent LVAD implantation, 2 (9.5...
Source: American Heart Journal - Category: Cardiology Source Type: research