Protocol‐Driven Best Practices and Cardiogenic Shock Survival in Asian Patients
Background Cardiogenic shock carries high mortality. This study investigated the relationship between protocol‐advocated best practices and outcomes. Methods Patients with cardiogenic shock supported by Impella CP in an Asian tertiary cardiac center were evaluated for 30‐day post percutaneous ventri...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2025-03-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.037742 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850155290462257152 |
|---|---|
| author | Calvin Leung Yan Hang Fong Michael Chi Shing Chiang Ivan Man Ho Wong Cheuk Bong Ho Yin Kei Yeung Chung Yin Leung Pok Him Lee Tai Chung So Yuet Wong Cheng Shing Fung Chui Alan Ka Chun Chan Chi Yuen Wong Kam Tim Chan William W. O'Neill Michael Kang Yin Lee |
| author_facet | Calvin Leung Yan Hang Fong Michael Chi Shing Chiang Ivan Man Ho Wong Cheuk Bong Ho Yin Kei Yeung Chung Yin Leung Pok Him Lee Tai Chung So Yuet Wong Cheng Shing Fung Chui Alan Ka Chun Chan Chi Yuen Wong Kam Tim Chan William W. O'Neill Michael Kang Yin Lee |
| author_sort | Calvin Leung |
| collection | DOAJ |
| description | Background Cardiogenic shock carries high mortality. This study investigated the relationship between protocol‐advocated best practices and outcomes. Methods Patients with cardiogenic shock supported by Impella CP in an Asian tertiary cardiac center were evaluated for 30‐day post percutaneous ventricular assist device (PVAD) survival after adopting a standardized protocol emphasizing early mechanical circulatory support (shock‐to‐PVAD time ≤180 minutes), pulmonary artery catheterization for invasive hemodynamics, and safe vascular access. Results Of 109 consecutive patients (mean age 58.5±11.2, 80.7% male, 67% acute myocardial infarction, 33% acute decompensated heart failure), 45 (41.3%), 33 (30.3%), and 31 (28.4%) were in SCAI Shock Stages C, D, and E, respectively. A suggestive trend of improving 30‐day survival was observed (56.8%, 63.9%, and 72.2% in successive one thirds, P1, P2, and P3 of patients), paralleling a similar trend in achievement of best practices. Patients achieving all 3 best practices significantly increased from 35.1% (P1) to 52.8% (P3) (P=0.026). Median shock‐to‐PVAD time reduced from 5 [interquartile range: 2–23] hours (P1) to 1.5 [1–5] hours (P3) (P for trend=0.014), whereas pulmonary artery catheterization utilization (80.6–86.1%) and device‐related major vascular complications (5.6–8.4%) remained relatively stable. Achieving more best practices was significantly associated with better 30‐day survival, with patients achieving all 3, 2, and ≤1 best practices had 30‐day survival rates of 75.0%, 63.6%, and 35.7%, respectively (P=0.043). In multivariate Cox regression analysis, shock‐to‐PVAD time >180 minutes remained an independent predictor of mortality (P=0.031). Conclusions Achievement of protocol‐advocated best practices, especially early shock recognition and prompt PVAD support in appropriate patients, was associated with improved outcomes with PVAD use in cardiogenic shock. Future studies are suggested to confirm the benefits of a protocolized approach and evaluate the value of individual best practices. |
| format | Article |
| id | doaj-art-9c208f0531a04552aa0356b50dac8afb |
| institution | OA Journals |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-9c208f0531a04552aa0356b50dac8afb2025-08-20T02:24:58ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-03-0114510.1161/JAHA.124.037742Protocol‐Driven Best Practices and Cardiogenic Shock Survival in Asian PatientsCalvin Leung0Yan Hang Fong1Michael Chi Shing Chiang2Ivan Man Ho Wong3Cheuk Bong Ho4Yin Kei Yeung5Chung Yin Leung6Pok Him Lee7Tai Chung So8Yuet Wong Cheng9Shing Fung Chui10Alan Ka Chun Chan11Chi Yuen Wong12Kam Tim Chan13William W. O'Neill14Michael Kang Yin Lee15Division of Cardiology Queen Elizabeth Hospital Hong Kong SARDivision of Cardiology Queen Elizabeth Hospital Hong Kong SARDivision of Cardiology Queen Elizabeth Hospital Hong Kong SARDivision of Cardiology Queen Elizabeth Hospital Hong Kong SARDivision of Cardiology Queen Elizabeth Hospital Hong Kong SARDivision of Cardiology Queen Elizabeth Hospital Hong Kong SARDivision of Cardiology Queen Elizabeth Hospital Hong Kong SARDivision of Cardiology Queen Elizabeth Hospital Hong Kong SARDivision of Cardiology Queen Elizabeth Hospital Hong Kong SARDivision of Cardiology Queen Elizabeth Hospital Hong Kong SARDivision of Cardiology Queen Elizabeth Hospital Hong Kong SARDivision of Cardiology Queen Elizabeth Hospital Hong Kong SARDivision of Cardiology Queen Elizabeth Hospital Hong Kong SARDivision of Cardiology Queen Elizabeth Hospital Hong Kong SARCenter for Structural Heart Disease Henry Ford Hospital Detroit MI USADivision of Cardiology Queen Elizabeth Hospital Hong Kong SARBackground Cardiogenic shock carries high mortality. This study investigated the relationship between protocol‐advocated best practices and outcomes. Methods Patients with cardiogenic shock supported by Impella CP in an Asian tertiary cardiac center were evaluated for 30‐day post percutaneous ventricular assist device (PVAD) survival after adopting a standardized protocol emphasizing early mechanical circulatory support (shock‐to‐PVAD time ≤180 minutes), pulmonary artery catheterization for invasive hemodynamics, and safe vascular access. Results Of 109 consecutive patients (mean age 58.5±11.2, 80.7% male, 67% acute myocardial infarction, 33% acute decompensated heart failure), 45 (41.3%), 33 (30.3%), and 31 (28.4%) were in SCAI Shock Stages C, D, and E, respectively. A suggestive trend of improving 30‐day survival was observed (56.8%, 63.9%, and 72.2% in successive one thirds, P1, P2, and P3 of patients), paralleling a similar trend in achievement of best practices. Patients achieving all 3 best practices significantly increased from 35.1% (P1) to 52.8% (P3) (P=0.026). Median shock‐to‐PVAD time reduced from 5 [interquartile range: 2–23] hours (P1) to 1.5 [1–5] hours (P3) (P for trend=0.014), whereas pulmonary artery catheterization utilization (80.6–86.1%) and device‐related major vascular complications (5.6–8.4%) remained relatively stable. Achieving more best practices was significantly associated with better 30‐day survival, with patients achieving all 3, 2, and ≤1 best practices had 30‐day survival rates of 75.0%, 63.6%, and 35.7%, respectively (P=0.043). In multivariate Cox regression analysis, shock‐to‐PVAD time >180 minutes remained an independent predictor of mortality (P=0.031). Conclusions Achievement of protocol‐advocated best practices, especially early shock recognition and prompt PVAD support in appropriate patients, was associated with improved outcomes with PVAD use in cardiogenic shock. Future studies are suggested to confirm the benefits of a protocolized approach and evaluate the value of individual best practices.https://www.ahajournals.org/doi/10.1161/JAHA.124.037742cardiogenic shock managementcardiogenic shock protocolImpella in cardiogenic shockmechanical circulatory supportpulmonary artery catheter in cardiogenic shock |
| spellingShingle | Calvin Leung Yan Hang Fong Michael Chi Shing Chiang Ivan Man Ho Wong Cheuk Bong Ho Yin Kei Yeung Chung Yin Leung Pok Him Lee Tai Chung So Yuet Wong Cheng Shing Fung Chui Alan Ka Chun Chan Chi Yuen Wong Kam Tim Chan William W. O'Neill Michael Kang Yin Lee Protocol‐Driven Best Practices and Cardiogenic Shock Survival in Asian Patients Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiogenic shock management cardiogenic shock protocol Impella in cardiogenic shock mechanical circulatory support pulmonary artery catheter in cardiogenic shock |
| title | Protocol‐Driven Best Practices and Cardiogenic Shock Survival in Asian Patients |
| title_full | Protocol‐Driven Best Practices and Cardiogenic Shock Survival in Asian Patients |
| title_fullStr | Protocol‐Driven Best Practices and Cardiogenic Shock Survival in Asian Patients |
| title_full_unstemmed | Protocol‐Driven Best Practices and Cardiogenic Shock Survival in Asian Patients |
| title_short | Protocol‐Driven Best Practices and Cardiogenic Shock Survival in Asian Patients |
| title_sort | protocol driven best practices and cardiogenic shock survival in asian patients |
| topic | cardiogenic shock management cardiogenic shock protocol Impella in cardiogenic shock mechanical circulatory support pulmonary artery catheter in cardiogenic shock |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.037742 |
| work_keys_str_mv | AT calvinleung protocoldrivenbestpracticesandcardiogenicshocksurvivalinasianpatients AT yanhangfong protocoldrivenbestpracticesandcardiogenicshocksurvivalinasianpatients AT michaelchishingchiang protocoldrivenbestpracticesandcardiogenicshocksurvivalinasianpatients AT ivanmanhowong protocoldrivenbestpracticesandcardiogenicshocksurvivalinasianpatients AT cheukbongho protocoldrivenbestpracticesandcardiogenicshocksurvivalinasianpatients AT yinkeiyeung protocoldrivenbestpracticesandcardiogenicshocksurvivalinasianpatients AT chungyinleung protocoldrivenbestpracticesandcardiogenicshocksurvivalinasianpatients AT pokhimlee protocoldrivenbestpracticesandcardiogenicshocksurvivalinasianpatients AT taichungso protocoldrivenbestpracticesandcardiogenicshocksurvivalinasianpatients AT yuetwongcheng protocoldrivenbestpracticesandcardiogenicshocksurvivalinasianpatients AT shingfungchui protocoldrivenbestpracticesandcardiogenicshocksurvivalinasianpatients AT alankachunchan protocoldrivenbestpracticesandcardiogenicshocksurvivalinasianpatients AT chiyuenwong protocoldrivenbestpracticesandcardiogenicshocksurvivalinasianpatients AT kamtimchan protocoldrivenbestpracticesandcardiogenicshocksurvivalinasianpatients AT williamwoneill protocoldrivenbestpracticesandcardiogenicshocksurvivalinasianpatients AT michaelkangyinlee protocoldrivenbestpracticesandcardiogenicshocksurvivalinasianpatients |