An Educational Curriculum for Residents, Advanced Practice Providers, and Fellows in Cardiac Intensive Care Units.

The contemporary cardiac intensive care unit (CICU) serves as a dynamic educational environment for postgraduate physicians and advanced practice provider trainees. This educational experience, however, can vary substantially between institutions. Specific learning objectives are needed to standardize the educational experience for trainees rotating through the contemporary CICU.

Comparison of Heart Failure Cardiogenic Shock patients with Axillary and Femoral Intra-aortic Balloon Pump: A CSWG report.

Objective: To describe the outcomes of patients receiving axillary (Ax) IABP and compare with those receiving Femoral (Fem) IABP for heart failure related cardiogenic shock (HF-CS).

Background: IABPs are traditionally placed via the femoral artery. Single center studies have shown the utility of axillary placement to promote ambulation.

Outcomes with Impella CP in Acute Myocardial Infarction versus Heart Failure Cardiogenic Shock: Insights from the Cardiogenic Shock Working Group.

Purpose: Impella CP (Abiomed, Danvers, MA) microaxial flow pumps are commonly used in acute myocardial infarction (AMI) and heart failure (HF) cardiogenic shock (CS). Contemporary data from large, unselected populations are needed to understand differences between these groups.

Methods: The Cardiogenic Shock Working Group (CSWG) registry enrolls patients with CS at 36 international sites.

CSWG-SCAI Stages Combined With Machine Learning-Based Phenotypes for Serial Risk Stratification in Cardiogenic Shock.

Background: Cardiogenic shock (CS) severity can be defined by the SCAI (Society for Cardiovascular Angiography and Interventions) stages (A to E), or machine learning-based phenotypes (I: noncongested, II: cardiorenal, III: cardiometabolic).

Objectives: This study aims to evaluate sequential applicability and prognostic relevance of combining SCAI stages and ML-based phenotypes for risk stratification of patients with CS.

Methods: The authors retrospectively applied both classification systems at 6- to 12-hour intervals for the first 72 hours to patients from the multicenter CSWG (Cardiogenic Shock Working Group) registry.

From Struggle to Triumph: A Journey Through SCAI Stages to Myocardial Recovery.

Cardiogenic shock (CS) is a time-sensitive, dynamic, and multifactorial syndrome that can progress quickly to multiorgan failure and become fatal if not addressed urgently. We present a case of a 47-year-old man who presented with non-ST-segment elevation myocardial infarction complicated by cardiogenic shock who was found to have ischemic cardiomyopathy with multivessel coronary artery disease. His clinical course was complicated by hemodynamic collapse requiring escalation of temporary mechanical circulatory support from intra-aortic balloon pump to Impella 5.

ECPELLA as a Bridge to Unexpected Myocardial Recovery in a Patient in Refractory Cardiogenic Shock.

Cardiogenic shock (CS) is a complex, multifactorial syndrome with substantial morbidity and mortality. Despite neutral results from randomized controlled trials, venoarterial extracorporeal membrane oxygenation (VA-ECMO) may be reasonable for select patients with refractory CS. A 37-year-old woman with morbid obesity and dilated nonischemic cardiomyopathy presented with Society of Cardiovascular Angiography and Intervention stage D biventricular CS, requiring vasopressor support and emergent escalation to ECPELLA, the combination of VA-ECMO and Impella (Abiomed), as a bridge to decision.

In-Hospital Outcomes and Readmissions in High-Risk Pulmonary Embolism Patients Requiring Extracorporeal Membrane Oxygenation Support.

There are limited data on the use of extracorporeal membrane oxygenation (ECMO) in high-risk pulmonary embolism (PE) patients. We analyzed the use of ECMO in high-risk PE patients (defined as requiring vasopressors, with cardiogenic shock, or cardiac arrest) using the National Readmission Database (2016-2020) to assess the outcomes of in-hospital mortality, hospitalization costs and length of stay (LOS). Among 130,486 patients, 1,685 (1.

Clinical outcomes of cardiogenic shock patients supported with VA-ECMO: Insights from the Cardiogenic Shock Working Group.

Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) use for cardiogenic shock (CS) is increasing worldwide despite conflicting results from randomized trials, which focused on myocardial infarction-related CS (MI-CS).

Methods: We performed a retrospective analysis of the Cardiogenic Shock Working Group multicenter registry to assess outcomes in CS in those supported with VA-ECMO. Continuous variables were presented as mean±SD or median+IQR for normal/non-normal distributions.

Outcomes of patients supported on Impella 5.5 for more than 14 days: A Cardiogenic Shock Working Group registry analysis.

Background: The Impella 5.5 (ABIOMED, Danvers, MA) is a micro-axial pump that is currently approved for up to 14 days of support in the United States. However, in clinical practice it is being used for longer durations of time, especially as a bridge to heart replacement therapies (HRT).

Renal Dysfunction Across the Spectrum of Cardiogenic Shock: Mechanisms, Clinical Implications, and Therapeutic Strategies.

Purpose Of Review: This review aims to elucidate the complex interplay between cardiogenic shock (CS) and renal function, detailing the mechanisms of kidney injury, identifying risk factors, and providing a framework for the diagnosis and management of acute kidney injury (AKI) in CS. We evaluate evidence supporting medical interventions, including vasopressors, inotropes, and mechanical circulatory support (MCS), in relation to renal outcomes.

Recent Findings: AKI affects up to 80% of patients with CS and is associated with higher mortality, especially when Renal Replacement Therapy (RRT) is required.

Outcomes With Femoral IABP in Heart Failure and Acute Myocardial Infarction-Related Cardiogenic Shock.

Background: Intra-aortic balloon pump (IABP) insertion has not been shown to improve mortality rates in acute myocardial infarction-related cardiogenic shock (AMI-CS) but is increasingly used in heart failure-related cardiogenic shock (HF-CS).

Objective: We sought to compare IABP-related outcomes in patients with HF-CS and AMI-CS.

Methods: The Cardiogenic Shock Working Group registry was queried for patients with CS receiving femoral IABPs as the first temporary mechanical circulatory support (tMCS) device.

Optimising trial design for cardiogenic shock: insights from the sixth Critical Care Clinical Trialists Workshop.

Despite substantial advancements in the management of cardiogenic shock, mortality rates remain greater than 40%. Trials have shown that increasing survival rates in cardiogenic shock is challenging. Even the most successful trials show 5-15% reductions in mortality, and gains have been restricted to acute myocardial infarction cardiogenic shock, representing approximately 5% of the population with cardiogenic shock.

Utilization and Outcomes of Temporary Percutaneous Right Ventricular Assist Devices in Cardiogenic Shock.

Acute right ventricular failure (RVF) is a common finding in cardiogenic shock (CS), yet the optimal method of supporting the failing RV remains unclear. This study aimed to describe CS patients receiving percutaneous right ventricular assist devices (pRVADs) using the multicenter Cardiogenic Shock Working Group (CSWG) registry. Among 6,201 patients with CS, 152 (2.

Evolution of Critical Care Cardiology: An Update on Structure, Care Delivery, Training, and Research Paradigms: A Scientific Statement From the American Heart Association.

Critical care cardiology refers to the practice focus of and subspecialty training for the comprehensive management of life-threatening cardiovascular diseases and comorbid conditions that require advanced critical care in an intensive care unit. The development of coronary care units is often credited for a dramatic decline in mortality rates after acute myocardial infarction throughout the 1960s. As the underlying patient population became progressively sicker, changes in organizational structure, staffing, care delivery, and training paradigms lagged.

Worsening Renal Function Is Common and Is Associated With Higher Mortality Rates in Cardiogenic Shock: A Cardiogenic Shock Working Group Report.

Background: Outcomes associated with worsening renal function (WRF) in cardiogenic shock (CS) remain poorly understood.

Objectives: To study the incidence of WRF in heart failure-CS (HF-CS) and acute myocardial infarction CS (AMI-CS), examine its association with in-hospital mortality (IHM) rates, define the trajectory of renal function in CS, and identify independent predictors of WRF in HF-CS vs AMI-CS.

Methods: Patients in the Cardiogenic Shock Working Group registry (CSWG) from 2021-2024 were analyzed; those with baseline end-stage renal disease were excluded.

International cooperation in cardiogenic shock is key to improving outcomes: Cardiogenic Shock Working Group impacts a single center in a developing country.

The Cardiogenic Shock Working Group (CSWG) is an international research consortium formed in 2016. The National Institute of Cardiology Ignacio Chavez joined in 2021 and launched a cardiogenic shock (CS) program in 2022. This study evaluates the impact of CSWG core standards on outcomes in a middle-income country reference center of 9,430 patients with CS (Society for Cardiovascular Angiography and Interventions [SCAI] stages B→E) from a registry of 28,054 admissions (2005-2023).

Differences Between Ischemic and Nonischemic Cardiomyopathy in Heart Failure Related Cardiogenic Shock.

Background: Heart failure-related cardiogenic shock (HF-CS) accounts for a growing proportion of cardiogenic shock (CS)-related admissions to contemporary cardiac intensive care units. Limited data exist comparing nonischemic (NICM) and ischemic cardiomyopathy (ICM) in this setting.

Methods And Results: We sought to examine the differences in patients' characteristics, in-hospital treatments and outcomes in individuals admitted with ICM and NICM HF-CS.

Epidemiology and Prognostic Significance of Acute Noncardiac Organ Dysfunction Across Cardiogenic Shock Subtypes.

Background: The epidemiology and prognostic significance of acute noncardiac organ dysfunction across cardiogenic shock (CS) subtypes are not well-defined.

Methods: CS admissions from 2017 to 2022 in the Critical Care Cardiology Trials Network Registry were classified as acute myocardial infarction-related CS (AMI-CS), acute-on-chronic heart failure-related CS (AoC HF-CS), or de novo HF-CS, and categorized as having at least moderate respiratory, kidney, liver, and/or neurological dysfunction using established criteria. Burden of organ dysfunction was defined as no noncardiac organ dysfunction (NOD), single organ dysfunction, or multiorgan dysfunction (≥2) (MOD).

Characteristics and Outcomes of Patients With Cardiogenic Shock and Clinically Significant Valvular Heart Disease: From the Critical Care Cardiology Trials Network.

Background: Cardiogenic shock (CS) can be complicated by severe valvular heart disease (VHD). We analyzed cardiac intensive care unit (CICU) admissions according to VHD status.

Methods And Results: The Critical Care Cardiology Trials Network is a multicenter network of tertiary CICUs.

Evolution of Critical Care Cardiology: An Update on Structure, Care Delivery, Training, and Research Paradigms: A Scientific Statement From the American Heart Association.

Critical care cardiology refers to the practice focus of and subspecialty training for the comprehensive management of life-threatening cardiovascular diseases and comorbid conditions that require advanced critical care in an intensive care unit. The development of coronary care units is often credited for a dramatic decline in mortality rates after acute myocardial infarction throughout the 1960s. As the underlying patient population became progressively sicker, changes in organizational structure, staffing, care delivery, and training paradigms lagged.

The Comparative Epidemiology, Pathophysiology and Management of Cardiogenic Shock Associated With Acute Myocardial Infarction and Advanced Heart Failure.

Cardiogenic shock (CS) results from low cardiac output caused by myocardial dysfunction, coupled with systemic end-organ tissue hypoperfusion and elevated ventricular filling pressures, along a spectrum of shock severity. This narrative review aims to compare the epidemiology, pathophysiology, and contemporary management of 2 common etiologies of CS caused by acute myocardial infarction (AMI-CS) and advanced heart failure (HF-CS). CS complicates up to 14% of AMI and 5% of HF admissions.