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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Survival after shock requiring high-dose vasopressor therapy
Samuel M Brown1, Michael J Lanspa1, Jason P Jones2
1Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UT; Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT.
Chest
|August 23, 2012
Summary
Few patients survive high-dose vasopressor therapy (HDV) for shock. Stress-dose corticosteroids may improve survival in these critical cases, warranting further investigation for better patient outcomes.
Area of Science:
- Critical Care Medicine
- Pharmacology
- Clinical Outcomes Research
Background:
- Some patients with hypotensive shock are refractory to standard vasopressor doses.
- Outcomes following high-dose vasopressor therapy (HDV) are poorly understood.
- This study investigates survival and corticosteroid use in patients requiring HDV.
Purpose of the Study:
- To characterize survival rates in patients with shock requiring HDV.
- To evaluate the association between stress-dose corticosteroid therapy and survival.
- To analyze factors influencing outcomes, including shock type and end-of-life care decisions.
Main Methods:
- Retrospective analysis of 443 patients in ICUs from 2005-2010.
- HDV defined as ≥ 1 μg/kg/min norepinephrine equivalent.
- Survival at 90 days, corticosteroid use, shock cause, CPR, and life support withdrawal were assessed.
Main Results:
- Overall 90-day survival was 17% (76/443 patients).
- Septic shock patients had similar survival (20%).
- Stress-dose corticosteroids were associated with improved survival (P = .01).
Conclusions:
- Approximately 17% of patients requiring HDV survived 90 days.
- Most non-survivors experienced withdrawal or withholding of life support.
- Stress-dose corticosteroids appear beneficial in patients needing HDV.
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