The Experts below are selected from a list of 309 Experts worldwide ranked by ideXlab platform
Dorothea Mcareavey - One of the best experts on this subject based on the ideXlab platform.
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advanced percutaneous mechanical circulatory support devices for Cardiogenic Shock
Critical Care Medicine, 2017Co-Authors: P Miller, Michael A Solomon, Dorothea McareaveyAbstract:Objectives:To review temporary percutaneous mechanical circulatory support devices for the treatment of Cardiogenic Shock, including current evidence, contraindications, complications, and future directions.Data Sources:A MEDLINE search was conducted with MeSH terms: Cardiogenic Shock, percutaneous
P Miller - One of the best experts on this subject based on the ideXlab platform.
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advanced percutaneous mechanical circulatory support devices for Cardiogenic Shock
Critical Care Medicine, 2017Co-Authors: P Miller, Michael A Solomon, Dorothea McareaveyAbstract:Objectives:To review temporary percutaneous mechanical circulatory support devices for the treatment of Cardiogenic Shock, including current evidence, contraindications, complications, and future directions.Data Sources:A MEDLINE search was conducted with MeSH terms: Cardiogenic Shock, percutaneous
Jeanlouis Teboul - One of the best experts on this subject based on the ideXlab platform.
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mechanical circulatory support devices for Cardiogenic Shock state of the art
Critical Care, 2019Co-Authors: Ludhmila Abrahao Hajjar, Jeanlouis TeboulAbstract:Cardiogenic Shock is the clinical expression of circulatory failure, as a consequence of left, right or biventricular dysfunction. Cardiogenic Shock is also defined as a state of critical end-organ hypoperfusion due to primary cardiac dysfunction [1–3]. Cardiogenic Shock is not simply a decrease in cardiac contractile function, but also a multiorgan dysfunction syndrome involving the entire circulatory system, often complicated by a systemic inflammatory response syndrome with severe cellular and metabolic abnormalities [4]. The clinical presentation of Cardiogenic Shock varies from hemodynamic abnormalities of pre-Shock to mild Shock, progressing to more profound Shock and finally refractory Shock, which invariably is associated with high mortality rates. Additional insults can occur, such as arrhythmias, vasodilation, ischemia and infection, acutely changing the trajectory of the disease [5]. The contemporary management of Cardiogenic Shock involves early diagnosis and directed therapy to optimize oxygen delivery and tissue perfusion.
Michael A Solomon - One of the best experts on this subject based on the ideXlab platform.
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advanced percutaneous mechanical circulatory support devices for Cardiogenic Shock
Critical Care Medicine, 2017Co-Authors: P Miller, Michael A Solomon, Dorothea McareaveyAbstract:Objectives:To review temporary percutaneous mechanical circulatory support devices for the treatment of Cardiogenic Shock, including current evidence, contraindications, complications, and future directions.Data Sources:A MEDLINE search was conducted with MeSH terms: Cardiogenic Shock, percutaneous
Holger Thiele - One of the best experts on this subject based on the ideXlab platform.
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Revascularization in Cardiogenic Shock
Herz, 2020Co-Authors: Anne Freund, Steffen Desch, Holger ThieleAbstract:In etwa 10 % der Fälle entwickelt sich bei Patienten mit akutem Myokardinfarkt ein kardiogener Schock. Nachdem randomisierte Studien eine deutliche Verbesserung der Überlebenswahrscheinlichkeit im Fall einer frühzeitigen Revaskularisierung belegten, bildet diese den wichtigsten Eckpfeiler in der Therapie des infarktbedingten Schocks. Im überwiegenden Teil der Fälle erfolgt die Revaskularisierung durch eine perkutane Koronarintervention. Bei einer komplexen Koronaranatomie oder dem Auftreten mechanischer Komplikationen des Herzinfarkts sollte zeitnah das Heart Team konsultiert werden. In der randomisierten CULPRIT-Shock-Studie zeigte sich im Fall einer koronaren Mehrgefäßerkrankung ein Überlebensvorteil für Patienten mit initial alleiniger Versorgung des infarktverursachenden Gefäßes im Vergleich zur sofortigen Mehrgefäßintervention bei einer perkutanen Revaskularisierungsstrategie. Bezüglich Empfehlungen zur Antikoagulation und Thrombozytenaggregationshemmung sowie zum Einsatz von aktiven Kreislaufunterstützungssystemen ist die zugrunde liegende Evidenz aktuell gering. Approximately 10% of patients with acute myocardial infarction develop Cardiogenic Shock. Randomized studies have shown a significant improvement in survival with early revascularization, which now represents the most important cornerstone in the treatment of infarct-related Cardiogenic Shock. In the vast majority of cases, this is achieved by percutaneous coronary intervention (PCI). In cases of complex coronary anatomy or mechanical complications, the Heart Team should be consulted promptly. The randomized CULPRIT-Shock study showed a survival advantage for patients with multivessel coronary artery disease and a percutaneous revascularization strategy who were treated by culprit-lesion-only PCI compared with immediate multivessel PCI. There are currently few data on anticoagulation and antiplatelet therapy in Cardiogenic Shock as well as on active mechanical circulatory support in this setting.
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Cardiogenic Shock: role of invasive cardiology.
Current Opinion in Critical Care, 2020Co-Authors: Hans-josef Feistritzer, Holger Thiele, Steffen DeschAbstract:Purpose of review Early revascularization significantly improved the outcome of patients with Cardiogenic Shock following acute myocardial infarction (AMI). Nevertheless, the mortality remains substantial, ranging between 40 and 50% after 30 days. The present review summarizes the current evidence regarding revascularization strategies, vascular access site and concomitant antiplatelet and antithrombotic treatment in infarct-related Cardiogenic Shock. Recent findings On the basis of the Shock trial, early revascularization is the most relevant procedure to improve the outcome of patients with infarct-related Cardiogenic Shock. The majority of these patients present with multivessel coronary disease. The randomized CULPRIT-Shock trial showed that in the emergency setting, percutaneous coronary intervention (PCI) should be confined to the culprit lesion. Regarding vascular access site, no data derived from randomized controlled trials in Cardiogenic Shock are available. Emergency coronary artery bypass grafting (CABG) is nowadays rarely performed in Cardiogenic Shock with rates less than 5% but is still a treatment option if coronary anatomy is not amenable to PCI. Regarding antiplatelet treatment, a randomized trial testing the intravenous P2Y12 inhibitor cangrelor versus an oral P2Y12 inhibitor in infarct-related Cardiogenic Shock is currently being performed. Summary Early revascularization is the cornerstone of treatment of infarct-related Cardiogenic Shock and should be confined to the culprit lesion in the emergency setting.
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Cardiogenic Shock Complicating Myocardial Infarction
Deutsche medizinische Wochenschrift (1946), 2020Co-Authors: Danilo Obradovic, Anne Freund, Steffen Desch, Holger ThieleAbstract:In patients admitted with acute myocardial infarction, Cardiogenic Shock remains the most common cause of death. Multidisciplinary care in a specialized center and guideline-compliant treatment of Cardiogenic Shock are crucial for the survival and prognosis of affected patients. Hemodynamic monitoring and stabilization by volume expansion, vasopressors and inotropes represent initial steps in the management of patients with Cardiogenic Shock. Nevertheless, early revascularization of the culprit-lesion is proved to be the most important treatment modality. Although the use of active mechanical circulatory support appears to be a promising therapeutic concept to improve clinical outcome in patients with infarct-related Cardiogenic Shock, in the few previous randomized trials mechanical circulatory support failed to show beneficial effects on short-term and long-term survival.
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incidence determinants and prognostic relevance of Cardiogenic Shock in patients with takotsubo cardiomyopathy
European heart journal. Acute cardiovascular care, 2016Co-Authors: Thomas Stiermaier, Steffen Desch, Holger Thiele, Gerhard Schuler, Charlotte Eitel, Georg Fuernau, Ingo EitelAbstract:Background:Takotsubo cardiomyopathy (TTC) can be accompanied by various life-threatening complications, including Cardiogenic Shock. The exact incidence and prognostic relevance of Cardiogenic Shock in TTC patients has not been studied in detail.Methods:The frequency and determinants of Cardiogenic Shock were evaluated in 178 patients with TTC. The clinical course and treatment strategies of TTC patients with Cardiogenic Shock were systematically analysed. Furthermore, short and long-term mortality rates were assessed with a structured telephone follow-up.Results:The incidence of Cardiogenic Shock in this large TTC population was 12.4%. Multivariable logistic regression analysis identified left ventricular ejection fraction as the only significant predictor of Cardiogenic Shock (odds ratio 0.80; 95% confidence interval (CI) 0.73–0.88; P<0.01). The majority of the TTC patients with Cardiogenic Shock were treated with catecholamine therapy (86%) and 59% received early initiated mechanical circulatory suppor...
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Cardiogenic Shock in patients with acute coronary syndromes
Oxford Medicine Online, 2016Co-Authors: Holger Thiele, Uwe ZeymerAbstract:Cardiogenic Shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the Cardiogenic Shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical left ventricular support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of Cardiogenic Shock complicating acute coronary syndromes, including mechanical complications and Shock from right heart failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist’s and an intensive care physician’s perspective on the advancement of new therapeutical arsenals, both mechanical percutaneous circulatory support and pharmacological support. Since studying the Cardiogenic Shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in Cardiogenic Shock.
