Do all nonsurvivors of cardiogenic shock die with a low cardiac index?
OBJECTIVE
To characterize the hemodynamic course of cardiogenic shock and to relate the cause of death to ongoing cardiac failure or multiple organ dysfunction.


METHODS
Retrospective study.


METHODS
A 31-bed department of intensive care in a university hospital.


METHODS
All patients admitted for cardiogenic shock from January 1999 to December 2000.


METHODS
None.


RESULTS
Charts were reviewed for demographic, clinical, hemodynamic, oxygen transport, inflammation, and organ dysfunction data. Of 62 patients with cardiogenic shock, 40 (65%) did not survive. Eight patients (20%) died from fatal arrhythmia, 14 patients (35%) died with low cardiac index (CI) [ie, < 2.2 L/min/m(2)], and 18 patients (45%) died with normalized CI (ie, > 2.2 L/min/m(2)) and a higher CI/oxygen extraction ratio. Of these 18 patients, 9 had evidence of infection. The patients with normalized CI were younger and stayed longer in the ICU than patients with low CI.


CONCLUSIONS
A substantial number of patients with cardiogenic shock die with a normalized CI, suggesting a distributive defect, in the absence of obvious infection. These patients are younger and have a longer ICU course. The release of mediators may be secondary to gut hypoperfusion.
Lim
Noelle
N
Department of Intensive Care, Erasme Hospital, Free University of Brussels, Belgium.
Dubois
Marc-Jacques
MJ
De Backer
Daniel
D
Vincent
Jean-Louis
JL
D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis; D002302:Cardiac Output; D002303:Cardiac Output, Low / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000150:complications; D010101:Oxygen Consumption; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000150:complications / Q000401:mortality* / Q000503:physiopathology*; D015996:Survival Rate; D014655:Vascular Resistance
D002097:C-Reactive Protein