[Management of cardiogenic shock: Results from a survey in France and Belgium].
OBJECTIVE
Physician survey on cardiogenic shock management; recommendations for the management of patients with cardiogenic shock are based mostly on experts' opinion.


METHODS
Overall 1585 emails were sent to "senior" intensive care physicians from France and Belgium from September 2014 to march 2015. Response rate was 10% (157 respondents). Agreement was assessed based on RAND/UCLA methodology.


RESULTS
Continuous monitoring of cardiac output, vascular filling, noninvasive ventilation were deemed appropriate. The use of systematic diuretics and dopamine seemed inappropriate. There was a strong agreement to use dobutamine as inotropic drug in first intention. The use of noradrenaline and adrenaline was considered appropriate. There was a strong agreement to use mechanical circulatory support, in particular extracorporeal life support, in refractory cardiogenic shock. Only 25% of responders felt that there are criteria of refractory cardiogenic shock. Concerning the objectives of systolic, diastolic and mean blood pressure, 95% of the responses were in the range between 70 to 100, 30 to 50, and 55 to 65mmHg, respectively. The target of SvO2was between 55% and 75%, and cardiac index between 1.5 and 3L/min/m2for 95% of responders. There was a strong agreement to maintain hemoglobin between 7 and 9.9g/dL.


CONCLUSIONS
Based on our physician survey, we found an agreement in vascular filling and early enteral nutrition. Dobutamine and noradrenaline should be the preferred drugs, but not dopamine. Mechanical circulatory support (preferably with extracorporeal support) should be restricted to refractory cardiogenic shock. Those responses differed slightly from experts' opinion, available in terms of recommendations.
Réanimation médicale et toxicologique, hôpital Lariboisière, 2, rue A.-Paré, 75010 Paris, France; Réanimation, clinique de Parly 2, Ramsay générale de santé, 21, rue Moxouris, 78150 Le Chesnay, France. Electronic address: champion.seb@wanadoo.fr.
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Champion
Réanimation médicale et toxicologique, hôpital Lariboisière, 2, rue A.-Paré, 75010 Paris, France.
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Deye
D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use*; D000328:Adult; D001530:Belgium; D002302:Cardiac Output; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D003422:Critical Care; D004280:Dobutamine / Q000627:therapeutic use*; D004837:Epinephrine / Q000627:therapeutic use*; D005104:Expert Testimony; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000188:drug therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000316:Adrenergic alpha-Agonists; D002316:Cardiotonic Agents; D004280:Dobutamine; D009638:Norepinephrine; D004837:Epinephrine
Cardiogenic shock; Choc cardiogénique; Enquête; Infarctus du myocarde; Management; Myocardial infarction; Pratiques; Survey