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REVIEW

CURRENT
OPINION An overview of international cardiogenic shock
guidelines and application in clinical practice
Sean van Diepen a,b,c and Holger Thiele d

Purpose of review
In this review, we compare central differences in cardiogenic shock recommendations in international
clinical practice guidelines, scientific statements, and the strength of the supporting evidence. Furthermore,
we discuss their associations with adherence to guidelines in registry studies.
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Recent findings
The evidence base underpinning American Heart Association/American College of Cardiology’s and
European Society of Cardiology’s recommendations for an early invasive approach is relatively strong, but
adherence to these recommendations is poor in registry and population-based studies. There is little
evidence supporting the use of temporary mechanical circulatory support or pulmonary arterial
catherization in cardiogenic shock, and international guidelines provide weak and conflicting
recommendations, yet studies show mechanical circulatory support use is rising exponentially while
pulmonary arterial catherization use remains low. Guidelines provide conflicting information on the optimal
first-line vasoactive agent and norepinephrine remains the most widely used agent.
Summary
There are some inconsistencies between individual guideline recommendations, but there are no consistent
associations between the strength of underlying evidence, weight of guideline recommendations, and
adherence to guidelines in clinical practice. Improved knowledge translation of recommendations with a
strong evidence base, together with research efforts to address priority cardiogenic shock research needs,
could serve-to-harmonize recommendations and improve patient outcomes.
Keywords
cardiogenic shock, clinical practice guidelines, knowledge translation

INTRODUCTION practice standards reported in many clinical regis-


Cardiogenic shock is a cardiac disorder that results tries [3,4]. Thus, efforts to improve outcomes in this
in life-threatening clinical and laboratory hypoper- high-acuity and high-risk population should be
&&
fusion of end-organ tissues [1 ]. In a contemporary focused on both knowledge translation to increase
multicenter registry, acute coronary syndromes the adoption of evidence-based best practices, and
(ACS, 81%), chronic heart failure (11%) and valvu- the evaluation of new therapeutic interventions
lar heart disease (6%) were the leading causes of through clinical trials. In this review, we compare
shock [2]. ST-segment elevation myocardial infarc- the differences in central cardiogenic shock thera-
tion (STEMI) is the best studied cause with an inci- peutic and monitoring guideline recommendations
dence of 6–10% and accounts for the majority of
ACS-associated cardiogenic shock [2,3]. Despite sig-
a
nificant temporal improvements in mortality fol- Department of Critical Care, bDivision of Cardiology, Department of
Medicine, cCanadian VIGOUR Center, University of Alberta, Edmonton,
lowing the publication of the SHOCK (Should We
Alberta, Canada and dHeart Center Leipzig at University of Leipzig and
Emergently Revascularize Occluded Coronaries for Leipzig Heart Institute, Leipzig, Germany
Cardiogenic Shock?) trial, outcomes remain rela- Correspondence to Sean van Diepen, MD, MSc, 2C2 Cardiology Walter
tively poor with short-term mortality rates of 40– MacKenzie Center, University of Alberta Hospital, 8440-11 St., Edmonton,
47% in clinical trials and 30–51% in registry studies AB, Canada T6G 2B7. Tel: +1 780 407 6948; fax: +1 780 407 7485;
& &
[3,4,5 ,6,7 ,8]. These temporal improvements, e-mail: sv9@ualberta.ca
however, may belie treatment disparities and/or Curr Opin Crit Care 2019, 25:365–370
the suboptimal application of evidence-based DOI:10.1097/MCC.0000000000000624

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Cardiogenic shock

&&
dysfunction [1 ]. PAC can also be used to monitor
KEY POINTS responses to vasoactive therapies, mechanical circu-
 There is no clear association between the weight of latory support (MCS), or fluid shifts, and can also
guideline recommendations and adherence to provide prognostic information, such as cardiac
guidelines in clinical practice. power output [14]. The effect of routine PAC use
on clinical outcomes in the cardiogenic shock
 Understanding the barriers to adherence to guideline
population, however, remains unclear. Multiple
recommendations, and priority efforts to implement best
practices could improve survival in cardiogenic shock. randomized trials in noncardiogenic shock popula-
tions have demonstrated either no benefit or harm
 Further cardiogenic shock research could potentially with routine PAC use, while small observational
help harmonize clinical practice studies have suggested reduced mortality in patients
guidelines recommendations.
with cardiogenic shock [15–17]. This clinical uncer-
tainty likely reflects the discrepancy in guideline
recommendations; the AHA/ACC STEMI and heart
across major American and European STEMI, failure guidelines lean toward routine use, while the
heart failure guidelines and cardiogenic shock sci- ESC guidelines both provide a class IIb recommen-
entific statements, qualitatively discuss if (in)con- dation [9–12]. The AHA scientific statement sugges-
sistencies in recommendations may be associated tion of PAC ‘in cases of diagnostic or cardiogenic
with practice variation, and propose priority shock management uncertainty or in patients
research needs to improve cardiogenic shock out- with moderate to severe cardiogenic shock who
&&
comes [1 ,9–13]. are unresponsive to initial therapy’ strikes a more
&&
intermediate stance [1 ]. These conflicting recom-
mendations, coupled with lack of evidence, are
DIFFERENCES IN CLINICAL PRACTICE likely reflected by the less than 10% PAC utilization
GUIDELINE AND SCIENTIFIC STATEMENT rate reported in population-based studies, and
CARDIOGENIC SHOCK highlight the need for dedicated trials in this popu-
RECOMMENDATIONS lation [3].
A summary of central monitoring and treatment
recommendations in the American Heart Associa-
tion (AHA)/American College of Cardiology (ACC) Vasoactive therapy
and European Society of Cardiology (ESC) STEMI The weight of existing clinical trial evidence sup-
and heart failure guidelines, the ESC revasculariza- ports the use of norepinephrine as a first-line vaso-
tion guidelines, and the AHA’s CS Scientific constrictive agent in patients with cardiogenic
Statement’s suggestions are summarized in Fig. 1.
&& &
shock if the blood pressure is low [18 ,19,20 ].
In this framework, Class I recommendations On the strength of these studies, a recent European
have evidence, or a general agreement, that an prospective cohort reported that the majority of
intervention is indicated. In Class II recommen- patients with cardiogenic shock are being treated
dations, there is conflicting evidence or opinion with norepinephrine (75%), while dopamine and
wherein Class IIa recommendations should be epinephrine are used in 26 and 21% (percentages
considered and IIb may be considered. Class III not-mutually exclusive), respectively [21]. Cur-
recommendations indicate that a treatment is not rently, none of the guidelines and statements have
recommended and may even cause harm. Recom- provided norepinephrine a class I recommenda-
mendations with level of evidence A are supported tion. The AHA/ACC heart failure guidelines list
by multiple randomized control trials (RCTs) or inotropes as a potential first-line vasoactive option
meta-analyses, level B are derived from single RCTs and, while both STEMI guidelines and the AHA
or large nonrandomized trials, whereas level scientific statement state that norepinephrine
C recommendations are based on expert opinion may be a safer alternative, the AHA/ACC STEMI
or small studies. guidelines and AHA scientific statement advocate
for an individualized approach based on cause and/
&&
or hemodynamic phenotype [1 ,9–12]. The latter
Monitoring therapeutic recommendation may be grounded in
There are multiple potential advantages of routine the recognition of the breadth of cardiogenic shock
pulmonary arterial catheterization (PAC) in patients severity, causes, and hemodynamics observed clin-
with cardiogenic shock. It can serve as a tool to help ically that have yet to be evaluated within clinical
confirm the diagnosis, severity, hemodynamic phe-
&&
trials [1 ,22]. This may explain the ongoing use of
notype, and the presence of right ventricular (RV) either dopamine or epinephrine in up to 50% of

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Overview of international cardiogenic shock guidelines van Diepen and Thiele

American Heart Associaon and/or American College of Cardiology European Society of Cardiology
2013 STEMI[9] 2013 Heart Failure[10] AHA Scienfic Statement[1] 2017 STEMI[11] 2016 Heart Failure[12] 2018 Revascularizaon[13]

Monitoring and Imaging


Echocardiogram 1C 1C Suggested IC IC None
(for all STEMI paents) (all paents) (without delaying angiography)
Pulmonary Arterial No Grade 1C Suggested IIb B IIb C None
Catheter “invasive monitoring to guide” (diagnosc or management
vasoacve therapy uncertainty)
Arterial Line None None Suggested IC IC None
Vasoacve Therapy
First line vasoacve No Grade Inotropes 1 C Individualized to phenotype and No Grade Inotropes IIb C No grade
Individualized therapy. eology “Dobutamine inial therapy” Norepinephrine IIb B “Inotropic support”
Dopamine may be “associated “Norepinephrine is associated with “Norepinephrine may be safer”
with excess hazard” fewer arrhythmias” than Dopamine
Fluid challenge None None Suggested No Grade IC None
“hypovolemia should be corrected” (if no signs of overload)
Venlatory support* None None Suggested IIa B NIMV IIa B NIMV No grade
I C IMV I C IMV “Venlatory support”
Revascularizaon
Early Invasive Approach IB None Suggested IA IC IB
PCI Revascularizaon of None None Suggested IRA only Complete index revascularizaon None III B
Mulvessel Disease (pending CULPRIT-SHOCK results) IIa C (Non-IRA revascularizaon)
Fibrinolysis IB None Suggested IIa C None None
(if not a candidate for PCI or (if early invasive approach cannot be (If PCI not available in ≤120 min)
CABG) completed in mely fashion)
CABG IB None Suggested IB None IB
(If anatomy not suitable for (individualized decisions for mul- (if anatomy not suitable for PCI) (if anatomy not amenable to
PCI) vessel or le main) PCI)
Mechanical Circulatory Support
IABP IIa B None Acute MR or VSD Suggested Roune III B III B III B
Acute MR or VSD IIa C
Temporary MCS IIb C IIa B Suggested IIb C IIb C IIb C
(paents selected by muldisciplinary
team)
Systems of Care
Transfer to PCI hospital 1B None Dedicated Cardiogenic Shock Systems of 1C 1C 1B
Care Suggested (all STEMI paents) (dedicated terary (regional network for all
center) STEMI)

FIGURE 1. Differences in selected cardiogenic shock international guideline recommendations and scientific statement
suggestions. AHA, American Heart Association; CABG, coronary artery bypass grafting; IABP, intra-aortic balloon pump; IRA,
infarct-related artery; IMV, invasive mechanical ventilation; MCS, mechanical circulatory support; MR, mitral regurgitation;
NIMV, noninvasive mechanical ventilation; PCI, percutaneous coronary intervention; STEMI, ST-segment elevation myocardial
infarction; VSD, ventricular septal defect. aPlease refer to each document for clinical criteria for intubation, invasive, and/or
noninvasive mechanical ventilation.

patients with cardiogenic shock and explain the mortality or renal replacement therapy with culprit-
&& &
lack of a strong endorsement of one agent in prac- lesion only revascularization [24 ,25 ]. This was
tice guidelines. Testing norepinephrine across the mainly driven by a significant reduction in 30-day
range of underlying etiologies, cardiogenic shock mortality. In addition, the guidelines provide guid-
severity, and in patients with RV dysfunction ance for emergency CABG in patients with anatomy
remain unanswered scientific questions in that is either not suitable for PCI or with multivessel
this field. disease, and allowances for selective fibrinolysis in
patients if timely PCI is not feasible. Alarmingly,
revascularization rates in both the United States and
Revascularization Europe remain suboptimal. In the French FAST-MI
The SHOCK trial demonstrated a significant reduc- program, only 57% of patients with STEMI compli-
tion in 6-month and long-term mortality among cated by cardiogenic shock underwent reperfusion
patients with a myocardial infarction (MI) compli- therapy in 2010, including 51% primary PCI, 3%
cated by cardiogenic shock undergoing an early CABG, and 6% prehospital fibrinolysis [4]. Similarly,
&
invasive approach [5 ]. In addition, there were no an American Nationwide Inpatient Sample reported
differences in outcomes between patients revascu- that in 2010 only 54% underwent PCI, 3% CABG,
larized with percutaneous coronary intervention and 4% fibrinolysis [3]. In the GRACE registry,
(PCI) or coronary artery bypass grafting (CABG), only 57% of patients with cardiogenic shock under-
although the revascularization strategy was not ran- went angiography, among whom 70% underwent
domized [23]. On the basis of this trial, current PCI and 16% underwent CABG [26]. Although the
international guidelines are consistent in their reasons underpinning the low utilization of revas-
strong recommendations for an early invasive cularization in STEMI patients complicated by car-
approach in MI complicated by cardiogenic shock. diogenic shock require further research, the low
All guidelines advocate a preference for PCI and the rates in both the United States and Europe despite
recent CULPRIT-SHOCK trial demonstrated a lower high-quality evidence and strong guideline recom-
30-day and 1-year combined endpoint consisting of mendations represent the biggest potential area

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Cardiogenic shock

wherein stronger adherence to guidelines could implantation in patients with MI complicated by


improve clinical outcomes. shock, the use of IABP has dropped significantly
&
[7 ,35,36]. Currently, ESC guidelines discourage
the use of routine IABP; the lone exception is the
Systems of care AHA/ACC STEMI guidelines which were published
To facilitate an early invasive approach, guidelines on-line the same year as the IABP SHOCK-II trial [9].
recommend the transfer of patients with cardio- The guidelines and scientific statement continue to
genic shock to a PCI-capable center. Based largely recommend IABP use in patients with mechanical
on studies showing improved outcomes in other complications of STEMI, given this high-risk group
complex and time-sensitive conditions that poten- was excluded from the IABP SHOCK-II trial, and
tially require multidisciplinary care, and modest based on theoretical assumptions. However, the
associations between higher cardiogenic shock hos- evidence behind this recommendation is only based
pital volume and increased adherence to guidelines on expert consensus and represents a level of
with reduced in-hospital mortality, there is a grow- evidence C.
ing call for formally established systems of cardio-
genic shock care that mirror those of other
conditions such as trauma, STEMI, and out-of-hos- ADOPTING EVIDENCE INTO PRACTICE
&&
pital cardiac arrest [1 ,27–31]. Thus far, studies In this qualitative assessment of clinical practice
have only demonstrated the feasibility of this guidelines, we observed some inconsistencies in
approach and this represents an important research the strength or level of evidence underpinning indi-
need [32]. vidual guideline common monitoring or treatment
recommendations across six international societal
guidelines. We hypothesize these differences may,
Mechanical circulatory support in part, be due to differences in the year of publica-
Arguably the most interesting disconnect between tion relative to seminal trials, differential interpre-
evidence and cardiogenic shock practice is the tation of lower quality evidence, and/or underlying
growing utilization of temporary MCS despite lack pathologies. In addition, there does not appear to be
of clear survival benefit and absence of strong a consistent association between the strength or
recommendations in practice guidelines. Cur- level of evidence and adherence to guidelines in
rently, there is no strong evidence from random- clinical practice. Somewhat paradoxically, the appli-
ized controlled trials showing that temporary MCS cation of Class I recommendations with a strong
devices improve mortality. Hence, the American evidence-base, such as an early invasive approach in
STEMI and European STEMI, heart failure, and suspected ACS, remains suboptimal while use of
revascularization guidelines provide a class IIb IABPs remains common despite the publications
recommendation, whereas the American heart fail- of IABP-SHOCK II trial and new class III recommen-
ure guidelines provide a class IIa recommendation dations in ESC guidelines. Although we acknowl-
[9– 13]. The AHA scientific statement suggests edge the well recognized delays between evidence
temporary over durable MCS to facilitate stabiliza- publications, guideline adoption, and change in
tion, a therapeutic procedure, allow full candidacy clinical practice, the relatively poor cardiogenic
evaluation, or when surgical risk is prohibitive, shock outcomes coupled with the lack of adherence
and that candidates should be selected by a to guidelines represent an important knowledge
&&
multidisciplinary team [1 ]. Despite these weak translation initiative that can potentially improve
endorsements, multiple studies have documented survival.
an exponential increase in the use of temporary
MCS, including veno-arterial extracorporeal
membrane oxygenation and Impella (Danvers, PRIORITY RESEARCH NEEDS
Massachusetts, USA) [6,33 –35]. We surmise that Our observation that only two of the cardiogenic
a strong belief in the efficacy of MCS among shock monitoring or treatment recommendations
clinicians may be driving this change in practice outlined in Fig. 1 received a consensus Class I rec-
in the absence of a strong evidence base, and eval- ommendation based on either level A or B of evi-
uating the efficacy, safety and patient selection dence (early invasive approach in suspected ACS,
may be the most pressing research priority in and CABG in patients with anatomy not suitable for
this field. PCI) may reflect both the relative paucity of research
Following the publication of the intra-aortic and the challenges of performing controlled trials in
balloon pump in cardiogenic shock II (IABP-SHOCK this population. Notwithstanding, these factors
II) trial, which showed no benefit with routine IABP coupled with the relatively poor outcomes in the

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Overview of international cardiogenic shock guidelines van Diepen and Thiele

Table 1. Proposed research needs in cardiogenic shock

Cardiogenic shock
treatment or monitoring Research need

Monitoring Testing outcomes of PAC use in patients with CS


Treatment Anti-inflammatory treatment targets in CS
Testing norepinephrine and the role of inotropes across a range of underlying pathologies, CS
severity, and in patients with RV dysfunction
Optimal hemodynamic/blood pressure targets
Interventional/Revascularization CABG or primary culprit only PCI revascularization in patients with CS and multivessel disease
Optimal anticoagulation strategies
Radial versus femoral access
MCS Testing if MCS devices save lives in CS
Head-to-head testing of MCS devices
Defining patients who may benefit from MCS
Role of ECMO in refractory cardiac arrest
Systems of care Testing if coordinated systems of care including dedicated CS centers improve survival
Knowledge translation Understanding barriers to adoption and the implementation of best practices

CABG, coronary artery bypass grafting; CS, cardiogenic shock; ECMO, extracorporeal membrane oxygenation; MCS, mechanical circulatory support; PAC,
pulmonary arterial catheterization; PCI, percutaneous coronary intervention; RV, right ventricular.

cardiogenic shock population help to highlight the Conflicts of interest


pressing need for more RCTs in this acute patient There are no conflicts of interest.
population. In Table 1, we propose some priority
research needs.
REFERENCES AND RECOMMENDED
READING
CONCLUSION Papers of particular interest, published within the annual period of review, have
been highlighted as:
Cardiogenic shock is an acute and potentially time- & of special interest
&& of outstanding interest
sensitive condition associated with high morbidity
and mortality. Population-based and registry-based 1. van Diepen S, Katz JN, Albert NM, et al. Contemporary management of
studies have identified some gaps in the application && cardiogenic shock: a scientific statement from the American Heart Associa-
tion. Circulation 2017; 136:e232–e268.
of guideline recommended practices, and efforts to Comprehensive scientific statement on the causes, work-up, monitoring and
improve outcomes will likely require improved therapies for cardiogenic shock.
2. Harjola VP, Lassus J, Sionis A, et al. Clinical picture and risk prediction of short-
knowledge translation and implementation strate- term mortality in cardiogenic shock. Eur J Heart Fail 2015; 17:501–509.
gies. Although cardiogenic shock clinical practice 3. Kolte D, Khera S, Aronow WS, et al. Trends in incidence, management, and
outcomes of cardiogenic shock complicating ST-elevation myocardial infarc-
guidelines largely concur, there is no consistent tion in the United States. J Am Heart Assoc 2014; 3:e000590.
association between the weight of guideline recom- 4. Aissaoui N, Puymirat E, Tabone X, et al. Improved outcome of cardiogenic
shock at the acute stage of myocardial infarction: a report from the USIK
mendations and adherence to guidelines in clinical 1995, USIC 2000, and FAST-MI French nationwide registries. Eur Heart J
practice. We recognize that the evidence-base 2012; 33:2535–2543.
5. Hochman JS, Sleeper LA, Webb JG, et al. Early revascularization in acute
underpinning many of these recommendations is & myocardial infarction complicated by cardiogenic shock. SHOCK Investiga-
weak or lacking, and improved collective research tors. Should we emergently revascularize occluded coronaries for cardio-
genic shock. N Engl J Med 1999; 341:625–634.
efforts to address the cardiogenic shock questions Practice changing randomized trial of early invasive approach in cardiogenic
identified herein could help harmonize interna- shock.
6. Mandawat A, Rao SV. Percutaneous mechanical circulatory support devices
tional cardiogenic shock guideline recommenda- in cardiogenic shock. Circ Cardiovasc Interv 2017; 10:e004337.
tions and clinical practice. 7. Thiele H, Zeymer U, Neumann F-J, et al. Intraaortic balloon support for
& myocardial infarction with cardiogenic shock. N Engl J Med 2012;
367:1287–1296.
Practice changing randomized trial of routine intra-aortic balloon pumps in cardio-
Acknowledgements genic shock.
8. Wayangankar SA, Bangalore S, McCoy LA, et al. Temporal trends and
We would like to thank Ms Leiah Louma for copyediting outcomes of patients undergoing percutaneous coronary interventions for
this article. cardiogenic shock in the setting of acute myocardial infarction: a report from
the CathPCI Registry. JACC Cardiovasc Interv 2016; 9:341–351.
9. O’Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA Guideline for
Financial support and sponsorship the Management of ST-Elevation Myocardial Infarction. A report of the
American College of Cardiology Foundation/American Heart Association
None. Task Force on Practice Guidelines. Circulation 2013; 127:e362–e425.

1070-5295 Copyright ß 2019 Wolters Kluwer Health, Inc. All rights reserved. www.co-criticalcare.com 369

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.


Cardiogenic shock

10. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA Guideline for the 22. van Diepen S. Norepinephrine as a first-line inopressor in cardiogenic shock:
Management of Heart Failure. A report of the American College of Cardiology oversimplification or best practice? J Am Coll Cardiol 2018; 72:183–186.
Foundation/American Heart Association Task Force on Practice Guidelines. J 23. White HD, Assmann SF, Sanborn TA, et al. Comparison of percutaneous
Am Coll Cardiol 2013; 128:e240–e327. coronary intervention and coronary artery bypass grafting after acute myo-
11. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the cardial infarction complicated by cardiogenic shock: results from the Should
management of acute myocardial infarction in patients presenting We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock
with ST-segment elevationThe Task Force for the management of acute (SHOCK) trial. Circulation 2005; 112:1992–2001.
myocardial infarction in patients presenting with ST-segment elevation of 24. Thiele H, Akin I, Sandri M, et al. PCI strategies in patients with acute myocardial
the European Society of Cardiology (ESC). Eur Heart J 2018; && infarction and cardiogenic shock. N Engl J Med 2017; 377:2419–2432.
39:119 – 177. Practice changing randomized trial of showing culprit only percutaneous coronary
12. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the intervention (PCI) superior to multivessell PCI in cardiogenic shock.
diagnosis and treatment of acute and chronic heart failure: The Task Force for 25. Thiele H, Akin I, Sandri M, et al. One-year outcomes after PCI strategies in
the diagnosis and treatment of acute and chronic heart failure of the European & cardiogenic shock. N Engl J Med 2018; 379:1699–1710.
Society of Cardiology (ESC). Developed with the special contribution of the One-year follow-up for culprit only versus multi-vessel PCI in cardiogenic shock.
Heart Failure Association (HFA) of the ESC. Eur Heart J 2016; 26. Awad HH, Anderson FA Jr, Gore JM, et al. Cardiogenic shock complicating
37:2129–2200. acute coronary syndromes: insights from the Global Registry of Acute
13. Kastrati A, Banning AP, Koller A, et al. 2018 ESC/EACTS Guidelines on Coronary Events. Am Heart J 2012; 163:963–971.
myocardial revascularization. Eur Heart J 2018; 40:87–165. 27. Granger CB, Henry TD, Bates WE, et al. Development of systems of care for
14. Fincke R, Hochman JS, Lowe AM, et al. Cardiac power is the ST-elevation myocardial infarction patients: the primary percutaneous cor-
strongest hemodynamic correlate of mortality in cardiogenic shock: a onary intervention ST-elevation myocardial infarction-receiving hospital per-
report from the SHOCK trial registry. J Am Coll Cardiol 2004; spective. Circulation 2007; 116:e55–e59.
44:340 – 348. 28. MacKenzie EJ, Rivara FP, Jurkovich GJ, et al. A national evaluation of the effect
15. Sandham JD, Hull RD, Brant RF, et al. A randomized, controlled trial of the use of trauma-center care on mortality. N Engl J Med 2006; 354:366–378.
of pulmonary-artery catheters in high-risk surgical patients. N Engl J Med 29. Mooney MR, Unger BT, Boland LL, et al. Therapeutic hypothermia after out-of-
2003; 348:5–14. hospital cardiac arrest: evaluation of a regional system to increase access to
16. Richard C, Warszawski J, Anguel N, et al. Early use of the pulmonary cooling. Circulation 2011; 124:206–214.
artery catheter and outcomes in patients with shock and acute respiratory 30. Shaefi S, O’Gara B, Kociol RD, et al. Effect of cardiogenic shock hospital
distress syndrome: a randomized controlled trial. JAMA 2003; volume on mortality in patients with cardiogenic shock. J Am Heart Assoc
290:2713–2720. 2015; 4:e001462.
17. Rossello X, Vila M, Rivas-Lasarte M, et al. Impact of pulmonary artery catheter 31. Rab T, Ratanapo S, Kern KB, et al. Cardiac shock care centers. J Am Coll
use on short- and long-term mortality in patients with cardiogenic shock. Cardiol 2018; 72:1972–1980.
Cardiology 2016; 136:61–69. 32. Beurtheret S, Mordant P, Paoletti X, et al. Emergency circulatory support in
18. De Backer D, Biston P, Devriendt J, et al. Comparison of dopamine and refractory cardiogenic shock patients in remote institutions: a pilot study (the
&& norepinephrine in the treatment of shock. N Engl J Med 2010; 362:779–789. cardiac-RESCUE program). Eur Heart J 2013; 34:112–120.
Practice changing randomized trial of norepeinephrine or dopamine in cardiogenic 33. Agarwal S, Sud K, Martin JM, Menon V. Trends in the use of mechanical
shock. circulatory support devices in patients presenting with ST-segment elevation
19. Levy B, Perez P, Perny J, et al. Comparison of norepinephrine-dobutamine myocardial infarction. JACC Cardiovasc Interv 2015; 8:1772–1774.
to epinephrine for hemodynamics, lactate metabolism, and organ function 34. Khera R, Cram P, Lu X, et al. Trends in the use of percutaneous ventricular
variables in cardiogenic shock. A prospective, randomized pilot study. Crit assist devices: analysis of national inpatient sample data, 2007 through 2012.
Care Med 2011; 39:450–455. JAMA Intern Med 2015; 175:941–950.
20. Levy B, Clere-Jehl R, Legras A, et al. Epinephrine versus norepinephrine for 35. Shah M, Patnaik S, Patel B, et al. Trends in mechanical circulatory support use
& cardiogenic shock after acute myocardial infarction. J Am Coll Cardiol 2018; and hospital mortality among patients with acute myocardial infarction and
72:173–182. noninfarction related cardiogenic shock in the United States. Clin Res Cardiiol
Randomized trial of norepihephrine or epinephrine for cardiogenic shock. 2018; 107:287–303.
21. Tarvasmaki T, Lassus J, Varpula M, et al. Current real-life use of vasopressors 36. Rathod KS, Koganti S, Iqbal MB, et al. Contemporary trends in cardiogenic shock:
and inotropes in cardiogenic shock – adrenaline use is associated with incidence, intra-aortic balloon pump utilisation and outcomes from the London
excess organ injury and mortality. Crit Care 2016; 20:208. Heart Attack Group. Eur Heart J Acute Cardiovasc Care 2018; 7:16–27.

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