A multidisciplinary network to save the lives of severe, persistent cardiogenic shock patients.
BACKGROUND
Severe, persistent cardiogenic shock is associated with very high morbidity and lethality. We therefore tried to improve the outcome of these patients using a network between local hospitals and a specialized heart center that has facilities for transplantation and ventricular assist device (VAD) implantation.


METHODS
Between 1998 and 2000, 50 patients, who were in cardiogenic shock (mean age 49 years, SD 14) despite high doses of at least three inotropic agents, were admitted to our specialized heart center. During the first 12 hours, we tried to stabilize the patient's condition, to reduce inotropic support agents, and to keep cardiac index above 2.4 L.min(-1).m(-2). According to this strategy, patients were allocated to medical treatment only, emergency VAD therapy, urgent VAD implantation, or heart transplantation. To assess variables potentially influencing patients' outcome, we performed univariate and multivariate analyses.


RESULTS
Early in-hospital mortality was 36% and late mortality was 10%. Overall survival at 1, 6, and 12 months of follow-up was 70%, 56%, and 52%, respectively. Even when the heart transplant patients were excluded, overall 12-months survival after cardiogenic shock was still 50%. Higher age, and the absence of sinus rhythm were the only independent risk factors for 12-month mortality.


CONCLUSIONS
Our data show that a network between cardiology departments of local hospitals and specialized heart centers can be life-saving for severe, persistent cardiogenic shock patients.
El-Banayosy
Aly
A
Department of Cardiothoracic Surgery, Heart Center North-Rhine Westfalia, Ruhr University of Bochum, Bad Oeynhausen, Germany. abanayosy@hdz-nrw.de
Cobaugh
Dagmar
D
Zittermann
Armin
A
Kitzner
Lukasz
L
Arusoglu
Latif
L
Morshuis
Michiel
M
Milting
Hendrik
H
Tenderich
Gero
G
Koerfer
Reiner
R
D000328:Adult; D005260:Female; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D012770:Shock, Cardiogenic / Q000401:mortality* / Q000601:surgery*