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Cardiogenic Shock

Date Last Search Run: Feb 01, 2022
Table last updated: Apr 02, 2022
Data last added: Mar 19, 2022

Recommendation RECOMMENDATION FOR INTERVENTION
STRENGTH OF EVIDENCE FOR INTERVENTION   SUPPORTIVE (Green) NEUTRAL (Yellow) AGAINST (Red) NOT YET GRADED (White)
1 (strong evidence exists)  
2 (fair evidence exists)    
3 (weak evidence exists)      


Interventions

Bypass/Direct to PCI
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) 6 year survival Patient OR Hochman JS., Sleeper LA., Webb JG., et al. Early revascularization and long-term survival in cardiogenic shock complicating acute myocardial infarction. JAMA 2006; 295(21):2511-5. Medline
I Supportive (Green) 1 year mortality Patient OR Hochman JS., Sleeper LA., White HD., et al. One-year survival following early revascularization for cardiogenic shock. JAMA 2001; 285(2):190-2. Medline
II Supportive (Green) Prediction of death Process ED-MD Hochman JS., Buller CE., Sleeper LA., Boland J., Dzavik V., Sanborn TA., et al. Cardiogenic shock complicating acute myocardial infarction--etiologies, management and outcome: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK? J Am Coll Cardiol 2000; 36(3 Suppl A):1063-70. Medline
II Supportive (Green) Survival Patient ED-MD Huang R., Sacks J., Thai H., et al. Impact of stents and abciximab on survival from cardiogenic shock treated with percutaneous coronary intervention. Catheter Cardiovasc Interv 2005; 65(1):25-33. Medline
II Supportive (Green) 30 day and 1 year mortality Patient Kunadian B., Vijayalakshmi K., Dunning J., et al. Should patients in cardiogenic shock undergo rescue angioplasty after failed fibrinolysis: Comparison of primary versus rescue angioplasty in cardiogenic shock patients. J Invasive Cardiol 2007; 19(5):217-23. Medline
II Supportive (Green) Inhospital mortality Patient PH-Paramedic Lettieri C., Savonitto S., De Servi S., et al. Emergency percutaneous coronary intervention in patients with ST-elevation myocardial infarction complicated by out-of-hospital cardiac arrest: Early and medium-term outcome. Am Heart J 2009; 157(3):569-575. Medline
II Supportive (Green) The main outcome measurements were 1) Total ischemic time, 2) in-hospital all-cause mortality, and 3) 1-year all-cause mortality. Patient Ortolani P., Marzocchi A., Marrozzini C., et al. Usefulness of prehospital triage in patients with cardiogenic shock complicating ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. Am J Cardiol 2007; 100(5):787-92. Medline
II Neutral (Yellow) Mortality Patient Dauerman HL., Ryan TJ. Jr., Piper WD., et al. Outcomes of percutaneous coronary intervention among elderly patients in cardiogenic shock: A multicenter, decade-long experience. J Invasive Cardiol 2003; 15(7):380-4. Medline
II Neutral (Yellow) Survival Patient Hochman JS., Sleeper LA., Webb JG., Sanborn TA., White HD., Talley JD., et al. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock. N Engl J Med 1999; 341(9):625-34. Medline
II Opposes (Red) 30-day mortality over age 75 Patient Dzavik V., Sleeper LA., Picard MH., et al. Outcome of patients aged >or=75 years in the Should we emergently revascularize occluded coronaries in cardiogenic shocK (SHOCK) trial: Do elderly patients with acute myocardial infarction complicated by cardiogenic shock respond differently to emergent revascularization? Am Heart J 2005; 149(6):1128-34. Medline
III Supportive (Green) Patient survival Patient Kimura Y., Ohba K., Sumida H., et al. A survival case of cardiogenic shock due to left main coronary artery myocardial infarction: Successful cooperation with on-site percutaneous coronary intervention and helicopter emergency medical service. Intern Med 2012; 51(14):1845-50. Medline
X Not Yet Graded (White) - Dzavik V., Sleeper LA., Cocke TP., et al. Early revascularization is associated with improved survival in elderly patients with acute myocardial infarction complicated by cardiogenic shock: A report from the SHOCK trial registry. Eur Heart J 2003; 24(9):828-37. Medline
X Not Yet Graded (White) - Jeger RV., Harkness SM., Ramanathan K., et al. Emergency revascularization in patients with cardiogenic shock on admission: A report from the SHOCK trial and registry. Eur Heart J 2006; 27(6):664-70. Medline
X Not Yet Graded (White) - Sleeper LA., Ramanathan K., Picard MH., et al. Functional status and quality of life after emergency revascularization for cardiogenic shock complicating acute myocardial infarction. J Am Coll Cardiol 2005; 46(2):266-273. Medline

Crystalloid Infusion
Level Direction Primary Outcome Patient/Process Setting Reference
I Neutral (Yellow) Mortality Patient ICU Lewis SR, Pritchard MW, Evans DJ, Butler AR, Alderson P, Smith AF, et al. Colloids versus crystalloids for fluid resuscitation in critically ill people. The Cochrane database of systematic reviews 2018; 8. Medline

Dopamine
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Mortality Patient Havel C., Arrich J., Losert H., Gamper G., et al. Vasopressors for Hypotensive Shock (Review). Cochrane Data Syst Rev 2011; (5):1-76. Medline

Epinephrine
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) Adverse events Process PH-Paramedic Patrick C, Ward B, Anderson J, Fioretti J, Rogers Keene K, Oubre C, et al. Prehospital Efficacy and Adverse Events Associated with Bolus Dose Epinephrine in Hypotensive Patients During Ground-Based EMS Transport. Prehospital & Disaster Med 2020; 35(5):495-500. Medline
II Neutral (Yellow) Refractory hypotension, rearrest, or death in the emergency department Patient ED-MD Weiss A, Dang C, Mabrey D, Stanton M, Feih J, Rein L, et al. Comparison of Clinical Outcomes with Initial Norepinephrine or Epinephrine for Hemodynamic Support After Return of Spontaneous Circulation. Shock 2021. Medline
III Supportive (Green) Increase in SBP Patient PH-Paramedic KA W, DM F. Efficacy of bolus-dose epinephrine to manage hypotension in the prehospital setting. Am J Emerg Med 2021; 50:71–5. Medline

Norepinephrine
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Mortality Patient Havel C., Arrich J., Losert H., Gamper G., et al. Vasopressors for Hypotensive Shock (Review). Cochrane Data Syst Rev 2011; (5):1-76. Medline
II Supportive (Green) Refractory ypotension, rearrest, or death in the emergency department Patient ED-MD Weiss A, Dang C, Mabrey D, Stanton M, Feih J, Rein L, et al. Comparison of Clinical Outcomes with Initial Norepinephrine or Epinephrine for Hemodynamic Support After Return of Spontaneous Circulation. Shock 2021. Medline

Passive leg raise
Level Direction Primary Outcome Patient/Process Setting Reference

Pericardiocentesis
Level Direction Primary Outcome Patient/Process Setting Reference


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