Occluded Coronaries for Cardiogenic Shock (SHOCK) trial.2 An institutional protocol that uses intra-aortic balloon pumps. (IABPs) only in those patients with. Following the IABP-SHOCK trial, a systematic review and meta-analysis of . Figure 2: Proposed new treatment strategy for cardiogenic shock. Pöss J(1), Köster J(2), Fuernau G(2), Eitel I(2), de Waha S(2), Ouarrak T(3), Lassus II (Intraaortic Balloon Pump in Cardiogenic Shock) trial.
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Even anterior wall myocardial infarction is associated with some amount of right ventricular infarction.
IABP is known to unload the left ventricle and improve the left sided perfusion. Logically shock 2 trial a percutaneous intervention this should improve the survival of a patient.
But strangely the Shock two trial negates this hypothesis [ 1 ].
It is possible that the missing link is that the survival in the placebo arm was improved by the use of inotropes, maybe the inotrope noradrenaline. We briefly discuss this theory postulated shock 2 trial others [ 2 ].
We also describe our experience shock 2 trial noradrenaline in 4 cases who presented to us with a blood pressure less than 65 mm Hg, systolic, for more than half an hour. This was a randomized, open label, multicentre trial.
This study included both medically treated patients with myocardial infarction as well as shock 2 trial who had primary PCI. Between June and Marchthey enrolled patients in the IABP arm and placebo, or control arm patients.
In this study In this trial there was a crossover of randomized patients.
SHOCK 2 – The Bottom Line
But we feel the control arm had the advantage. Shock 2 trial mortality reduction may have been caused by the inotropes given. We have not been able to determine the exact doses of the inotropes given to individual patients shock 2 trial the better option might have been noradrenaline.
Strangely the IABP arm had more new onset renal failure [ 4 ]. It is the inotropes in these patients that might have improved on survival and negated the difference between the two arms. To summarize, surprisingly better results in the placebo arm may have confounded the results.
Price LC et al. They have highlighted the ICU management of RV dysfunction as having the following steps-1 Infusing fluids with caution so as not to increase the RV after load.
IABP maintains only the aortic pressure. It does not augment the right ventricular output as noradrenaline may. These authors have highlighted an interesting point.
Intra-Aortic Balloon vs. Impella Shows Similar Mortality Rates in MI With Cardiogenic Shock
Increase in the PVR pulmonary vascular resistance to a level more than the SVR systemic vascular resistance has been found to be detrimental to RV function. This reduces the perfusion to the right coronary artery which becomes only diastolic flow.
Normally the right shock 2 trial artery is perfused both by systolic flow or diastolic flow. Noradrenaline is a predominantly alpha adrenergic receptor agonist so shock 2 trial increases the blood pressure and the systemic vascular resistance and improves the coronary perfusion.
Our Experience We have already sent for publication our small series of cardiogenic shock patients who were on noradrenaline under consideration for publication.
Risk Stratification for Patients in Cardiogenic Shock After Acute Myocardial Infarction.
Med Klin Intensivmed Notfmed. In current international guidelines, intraaortic balloon counterpulsation is considered to be a class I treatment for cardiogenic shock complicating acute myocardial infarction. Patients and investigators were shock 2 trial masked to treatment allocation.