FLUID RESUSCITATION IN CARDIOGENIC SHOCK: AN ASSESSMENT OF RESPONSIVENESS AND OUTCOME

Authors

  • Aziz-ur Rehman Memon National Institute of Cardiovascular Diseases, Karachi, Pakistan
  • Muhammad Imran Ansari National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
  • Shahbaz Ali Shaikh National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
  • Jawed Abubaker National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
  • Musa Karim National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
  • Nawal Salahuddin National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan

Keywords:

cardiogenic shock, myocardial infarction, left ventricular dysfunction, fluid resuscitation, right ventricle dysfunction, passive leg raise, velocity time integral

Abstract

Background: Fluid replacement for resuscitation in cardiogenic shock (CS) patients remains a point of debate in clinical practice. The purpose of the study was to assess the frequency of fluid responsiveness and outcomes of patients with cardiogenic shock receiving fluid resuscitation at the critical care unit (ICU) of a tertiary care cardiac center. Methods: In this descriptive case series, in which all mechanically ventilated CS patients were evaluated who were assessed for fluid responsiveness by a fluid challenge. It was conducted at the critical care unit of a tertiary care cardiac center in Karachi, Pakistan, from January 2020 to June 2020, by including 41 consecutive patients. Fluid challenge was given as either a 250 ml crystallized bolus or a passive leg raise (PLR) manoeuvre. An increase in the velocity time integral (∆VTI) of ≥ 10% was considered fluid responsiveness. Results: A total of 41 patients were evaluated: 25 (61%) were males, and the mean age was 61.9±17.0 years, and 36.6% (15) of the patients presented with non-ST elevation myocardial infarction (NSTEMI), followed by anterior wall ST elevation myocardial infarction (31.7% (13)). Fluid responsiveness was observed in 48.8% (20/41). Mean VTI change after the fluid challenge was 1.07±0.86. Survival rate was 33.3% (7/21) in fluid responders vs. 50.0% (10/20) in non-fluid responders; p=0.279. Conclusion: Almost half of patients presenting with CS from acute coronary syndrome are responsive to fluids. These findings support the routine evaluation by fluid challenge in these patients. Fluid challenge can be by either PLR or fluid bolus.

References

Rathod KS, Koganti S, Iqbal MB, Jain AK, Kalra SS, Astroulakis Z, et al. Contemporary trends in cardiogenic shock: Incidence, intra-aortic balloon pump utilisation and outcomes from the London Heart Attack Group. Eur Heart J Acute Cardiovasc Care 2018;7(1):16–27.

Backhaus T, Fach A, Schmucker J, Fiehn E, Garstka D, Stehmeier J, et al. Management and predictors of outcome in unselected patients with cardiogenic shock complicating acute ST-segment elevation myocardial infarction: results from the Bremen STEMI Registry. Clin Res Cardiol 2018;107(5):371–9.

Basir MB, Kapur NK, Patel K, Salam MA, Schreiber T, Kaki A, et al. Improved outcomes associated with the use of shock protocols: updates from the National Cardiogenic Shock Initiative. Catheter Cardiovasc Interv 2019;93(7):1173–83.

Thiele H, Ohman EM, de Waha-Thiele S, Zeymer U, Desch S. Management of cardiogenic shock complicating myocardial infarction: An update 2019. Eur Heart J 2019;40(32):2671–83.

Van Diepen S, Katz JN, Albert NM, Henry TD, Jacobs AK, Kapur NK, et al. Contemporary management of cardiogenic shock: a scientific statement from the American Heart Association. Circulation 2017;136(16):e232–68.

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. J Am Coll Cardiol 2000;36(3 Suppl 1):1063–70.

Mandawat A, Rao SV. Percutaneous mechanical circulatory support devices in cardiogenic shock. Circ Cardiovasc Interv 2017;10(5):e004337.

Inohara T, Kohsaka S, Fukuda K, Menon V. The challenges in the management of right ventricular infarction. Eur Heart J Acute Cardiovasc Care 2013;2(3):226–34.

Members WC, Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction—executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction). J Am Coll Cardiol 2004;44(3):671–719.

Gumina RJ, Murphy JG, Rihal CS, Lennon RJ, Wright RS. Long-term survival after right ventricular infarction. Am J Cardiol 2006;98(12):1571–3.

Cherpanath TG, Hirsch A, Geerts BF, Lagrand WK, Leeflang MM, Schultz MJ, et al. Predicting fluid responsiveness by passive leg raising: A systematic review and meta-analysis of 23 clinical trials. Crit Care Med 2016;44(5):981–91.

Omote K, Nagai T, Iwano H, Tsujinaga S, Kamiya K, Aikawa T, et al. Left ventricular outflow tract velocity time integral in hospitalized heart failure with preserved ejection fraction. ESC Heart Fail 2020;7(1):168–76.

Delicce AV, Makaryus AN. Physiology, Frank Starling Law. StatPearls Publishing, Treasure Island (FL); 2020.

Guyton AC, Lindsey AW, Abernathy B, Richardson T. Venous return at various right atrial pressures and the normal venous return curve. Am J Physiol 1957;189(3):609–15.

Gavelli F, Monnet X, Teboul JL. Right Ventricular Dysfunction and Fluid Administration in Critically Ill Patients. Annual Update in Intensive Care and Emergency Medicine 2020. Vincent JL (ed): Springer, Cham, Switzerland, 2020; p.145–52.

Holubarsch C, Ruf T, Goldstein DJ, Ashton RC, Nickl W, Pieske B, et al. Existence of the Frank-Starling mechanism in the failing human heart: investigations on the organ, tissue, and sarcomere levels. Circulation 1996;94(4):683–9.

Marik PE. Obituary: pulmonary artery catheter 1970 to 2013. Ann Intensive Care 2013;3(1):1–6.

Downloads

Published

2021-06-30