Kardiogener Schock

Do All Nonsurvivors of Cardiogenic Shock Die With a Low Cardiac Index?

Noelle Lim, Marc-Jacques Dubois, Daniel De Backer, et al.                                                                                      CHEST 2003; 124:1885-1891

Medical Intensive Care Unit, ACZA Campus Stuivenberg, Lange Beeldekensstraat 267, 2060 Antwerp, Belgium.

STUDY OBJECTIVE: To characterize the hemodynamic course of cardiogenic shock and to relate the cause of death to ongoing cardiac failure or multiple organ dysfunction.
DESIGN: Retrospective study.
SETTING: A 31-bed department of intensive care in a university hospital.
PATIENTS: All patients admitted for cardiogenic shock from January 1999 to December 2000.
INTERVENTIONS: None.
MEASUREMENTS AND RESULTS: Charts were reviewed for demographic, clinical, hemodynamic, oxygen transport, inflammation, and organ dysfunction data. Of 62 patients with cardiogenic shock, 40 (65%) did not survive. Eight patients (20%) died from fatal arrhythmia, 14 patients (35%) died with low cardiac index (CI) [ie, < 2.2 L/min/m2], and 18 patients (45%) died with normalized CI (ie, > 2.2 L/min/m2) and a higher CI/oxygen extraction ratio. Of these 18 patients, 9 had evidence of infection. The patients with normalized CI were younger and stayed longer in the ICU than patients with low CI.
CONCLUSIONS: A substantial number of patients with cardiogenic shock die with a normalized CI, suggesting a distributive defect, in the absence of obvious infection. These patients are younger and have a longer ICU course. The release of mediators may be secondary to gut hypoperfusion.