In this before-after monocenter study, the authors teste the hypothesis that the implementation of a dedicated shock team could improve the outcome of patients with refractory cardiogenic shock assisted by mechanical circulatory support.
Short Term Mechanical Circulatory Support (STMCS) are the last resort therapeutics when refractory cardiogenic shock occurs. Growing technical possibilities like impella make the right choice at the right time challenging. At Bordeaux University Hospital, we have gathered the main protagonists which are the surgeon, the interventional cardiologist,and the intensivist as a shock team in January 2013. From that time, diagnosis of refractory cardiogenic shock triggers a multidisciplinary meeting driven by a common algorithm. The objective of this study is to perform a before-after comparison between decision of STMCS for refractory cardiogenic shock without shock team from january 2007 to january 2013 and after implementation of the shock team from April 2013 to April 2019.
Study Type
OBSERVATIONAL
Enrollment
250
retrospective study : standard of care
Bordeaux University Hospital
Pessac, France
Vital status
Proportion of patients alive
Time frame: One year after short term mechanical circulatory support initiation
Vital status
proportion of patients alive
Time frame: 30 days after short term mechanical circulatory support initiation
Vital status
proportion of patients alive
Time frame: 3 months after short term mechanical circulatory support initiation
Vital status
proportion of patients alive
Time frame: 6 months after short term mechanical circulatory support initiation
Lenght of stay
Intensive Care Unit length of stay
Time frame: up to Intensive Care Unit discharge, an average of 15 days
Lenght of stay
Hospital length of stay
Time frame: up to one year
Long term mechanical circulatory support
proportion of patients bridged to long term mechanical circulatory support
Time frame: up to intensive care unit discharge, an average of 15 days
Heart transplantation
proportion of patients bridged to heart transplantation
Time frame: up to intensive care unit discharge, an average of 15 days
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Weaning from short term mechanical circulatory support
proportion of patients sucessfully weaned from short term mechanical circulatory support
Time frame: up to seven days from weaning attempt
New renal replacement therapy
proportion of patients needing renal replacement therapy
Time frame: up to intensive care unit discharge, an average of 15 days
Limb ischaemia
proportion of patients with limb ischaemia
Time frame: through short term mechanical circulatory support weaning, an average of 6 days
Stroke
proportion of patients with stroke
Time frame: through short term mechanical circulatory support weaning, an average of 6 days
Short term mechanical circulatory support duration
Short term mechanical circulatory support duration
Time frame: through short term mechanical circulatory support weaning, an average of 6 days
Severe haemorrage
proportion of patients with severe haemorrage (massive haemorrhage according to SFAR or use of Novoseven or rescue surgery for bleeding)
Time frame: through short term mechanical circulatory support weaning, an average of 6 days
Extra Corporeal Membrane Oxygenation circuit clotting
proportion of patients in which Extra Corporeal Membrane Oxygenation circuit clotting occured
Time frame: through short term mechanical circulatory support weaning, an average of 6 days
Sepsis
proportion of patients in which sepsis occured
Time frame: up to intensive care unit discharge, an average of 15 days
Vital status
proportion of patients alive when bridged to long term mechanical circulatory device or when transplanted
Time frame: One year after short term mechanical circulatory support initiation
Vital status
proportion of patients alive when bridged to long term mechanical circulatory device or when transplanted
Time frame: 30 days after short term mechanical circulatory support initiation
Vital status
proportion of patients alive when bridged to long term mechanical circulatory device or when transplanted
Time frame: 3 months after short term mechanical circulatory support initiation
Vital status
proportion of patients alive when bridged to long term mechanical circulatory device or when transplanted
Time frame: 6 months after short term mechanical circulatory support initiation