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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Application of pulse index continuous cardiac output system in elderly patients with acute myocardial infarction
Yuan-Bo Zhang1, Zhi-Zhong Zhang2, Jun-Xia Li1
1Department of Cardiovascular Medicine, The Seventh Medical Center, General Hospital of the Chinese PLA, Beijing 100700, China.
Insights
Pulse index continuous cardiac output (PiCCO) monitoring improved clinical outcomes in elderly patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). This technology enhances hemodynamic management and reduces intensive care unit stays.
Area of Science:
- Cardiology
- Intensive Care Medicine
- Medical Technology
Background:
- Cardiogenic shock (CS) from acute myocardial infarction (AMI) presents significant management challenges and poor prognosis, especially in elderly patients.
- Accurate hemodynamic monitoring is critical for effective management of CS.
- Pulse index continuous cardiac output (PiCCO) monitoring offers precise assessment of cardiovascular and hemodynamic parameters.
Purpose of the Study:
- To evaluate the utility of the PiCCO system in improving management and clinical outcomes for elderly patients with AMI complicated by CS.
- To assess the impact of PiCCO monitoring on key clinical and hemodynamic markers.
Main Methods:
- Randomized controlled trial involving elderly patients with AMI and CS.
- Comparison of PiCCO monitoring versus standard care.
- Assessment of APACHE II, SOFA scores, biomarkers (hs-TnI, NT-proBNP), gas exchange (PaO2/FiO2), lactate, fluid balance, and hemodynamic indices (CI, EVLWI, ITBVI, GEDVI).
Main Results:
- The PiCCO group demonstrated significantly lower APACHE II and SOFA scores, hs-TnI, and NT-proBNP levels.
- Patients in the PiCCO group required shorter durations of vasoactive agents and mechanical ventilation, with reduced ICU length of stay.
- Hemodynamic parameters showed improved cardiac index (CI) and reduced extravascular lung water index (EVLWI), intrathoracic blood volume index (ITBVI), and global end diastolic volume index (GEDVI) over time.
Conclusions:
- The application of the PiCCO system can significantly improve clinical outcomes in elderly patients experiencing AMI complicated by CS.
- PiCCO monitoring facilitates better hemodynamic management, leading to enhanced patient recovery.
Background:
Cardiogenic shock (CS) secondary to acute myocardial infarction (AMI) complicates management of the condition, and often leads to poor prognosis. Prompt and accurate monitoring of cardiovascular and accompanying hemodynamic changes is crucial in achieving adequate management of the condition. Advances in technology has availed procedures such as pulse index continuous cardiac output (PiCCO), which can offer precise monitoring of cardiovascular functions and hemodynamic parameters. In this study, PiCCO is evaluated for its potential utility in improving management and clinical outcomes among elderly patients with AMI complicated by CS.
Aim:
To assess whether use of the PiCCO system can improve clinical outcomes in elderly patients with AMI complicated by CS.
Methods:
Patients from emergency intensive care units (EICU) or coronary care units (CCU) were randomized to receive PiCCO monitoring or not. The APACHE II score, SOFA score, hs-TnI, NT-proBNP, PaO2/FiO2 ratio and lactate levels on day 1, 3 and 7 after treatment were compared. The infusion and urine volume at 0-24 h, 24-48 h and 48-72 h were recorded, as were the cardiac index (CI), extravascular lung water index (EVLWI), intrathoracic blood volume index (ITBVI) and global end diastolic volume index (GEDVI) at similar time intervals.
Results:
Sixty patients with AMI complicated by CS were included in the study. The PiCCO group had a significantly lower APACHE II score, SOFA score, hs-TnI and NT-proBNP levels on day 1, 3 and 7 after treatment. The infusion and urine volume during 0-24 h in the PiCCO group were significantly greater, and this group also showed significantly higher ADL scores. Furthermore, the PiCCO group spent lesser days on vasoactive agents, mechanical ventilation, and had a reduced length of stay in EICU/CCU. Additionally, the CI was significantly higher at 48 h and 72 h in the PiCCO group compared with that at 24 h, and the EVLWI, ITBVI and GEDVI were significantly decreased at 48 h and 72 h.
Conclusion:
Applying the PiCCO system could improve the clinical outcomes of elderly patients with AMI complicated by CS.
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