Principal Investigator: Stavros Drakos
Keywords: Cardiogenic Shock Department: Cardiovascular Medicine
IRB Number: 00080080 Co Investigator: Stavros Drakos
Specialty: Cardiology
Sub Specialties: Heart Failure
Recruitment Status: Recruiting

Contact Information

Heather Hanson
heather.hanson@hsc.utah.edu
801-585-2490

Simple Summary

During the last two decades the incidence of acute cardiogenic shock has declined from 12-13% to 5-6% [1]. The increased usage of primary percutaneous coronary interventions has likely played a role in this decline [1]. Despite the reduction in the incidence of cardiogenic shock, the mortality is still around 50% [1, 2]. The high mortality rate of cardiogenic shock has led to the development of several new therapies to assist in the treatment of acute cardiogenic shock [3-5]. Given the heterogeneous nature of the condition and complexity of decision making in the era of newly developed treatment options, experts agree that a multi-disciplinary approach would the best strategy. Despite the consensus of the community, there is a scarcity of published data on clinical impacts of the multidisciplinary team approach or the “Shock Team” approach.We will enroll patients presenting with cardiogenic shock to the University of Utah hospital. The estimated duration for the UCAR-Shock Registry is 3 years. We estimate to enroll 40-50 patients. Depending on the initial presentation and etiology of cardiogenic shock, patients will be divided into two cohorts. Patients presenting with cardiogenic shock from acute coronary syndrome (ACS) will be assigned to Cohort 1. Patients presenting with cardiogenic shock from other etiologies will be assigned to Cohort 2. We will prepare two separate consent forms for two different group, depending on the need for a cardiac MRI. A generic consent form for the registry study will be provided for all patients in Cohort 2 and selected patients in Cohort 1 (ie. patients who declines MRI studies or have contraindications to MRI studies). A different consent form with information on cardiac MRI will be provided to Cohort 1 patients who are eligible for cardiac MRI.

Inclusion Criteria

  1. ≥ 18 years of age
  2. Patients presenting with cardiogenic shock with one of the following:
    1. acute coronary syndrome (including ST elevation myocardial infarction and non-ST elevation myocardial infarction)
    2. decompensated chronic heart failure
    3. myocarditis
    4. cardiac allograft rejection
    5. post-cardiotomy shock
    6. cardiogenic shock resulting from other etiologies not listed above that are determined by the investigator to be relevant to the proposed study

Cardiogenic shock will be defined as:

ONE of the following:

  • Systolic blood pressure (SBP) of less than 90 mm Hg or mean arterial pressure (MAP) less than 50 mmHg for more than 30 minutes
  • need for infusion of inotropes/vasoactive agents to maintain a SBP above 90 mmHg or MAP above 50 mmHg 
  • need for mechanical circulatory support (MCS) to maintain SBP above 90 mmHg or MAP above 50 mmHg

AND

ONE of the following:

  • Pulmonary capillary wedge pressure (PCWP) or left ventricular end diastolic pressure (LVEDP) > 15 mmHg AND Cardiac Index (CI) < 2.2 L/min/m²
  • Clinical or radiological signs of pulmonary edema
  • Impaired end-organ perfusion defined as at least ONE of the following:
    • altered mental status 
    • cold, clammy skin and extremities 
    • oliguria with urine output of less than 30 ml per hour
    • Serum lactate above 2 mmol/L
    • Ischemic liver injury

Exclusion Criteria

  1. Neither patient nor patient representative understands spoken English
  2. Neither patient nor patient representative is willing to give written consent for participation
  3. Pregnancy- excluded due to MRI contrast.

Participant Reimbursement

$150 for completing MRI