Faculty of Medicine
Library of the School of Health Sciences

2023-06-06

2023

Panagiotou Chrysoula-Anthoula

Ηλιοδρομίτης Ευστάθιος, Ομότιμος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Δημοπούλου Ιωάννα-Μαρία, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Ραλλίδης Λουκιανός, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Πάντος Κωνσταντίνος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Τούτουζας Κωνσταντίνος του Παύλου, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Τσαγκάρης Ηρακλής, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Αγγουράς Δημήτριος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ

Οργάνωση μονάδας προχωρημένης καρδιακής ανεπάρκειας

Greek

Organisational structure of an advanced heart failure clinic and treatment decision making

Objective: To evaluate the impact of organizational structure in the treatment decision making concerning the temporary mechanical circulatory support and to evaluate the effectiveness of these interventions applied to patients with acute advanced heart failure with cardiogenic shock admitted to the cardiac intensive care unit in a tertiary hospital. Also to study the outcome in relation to the escalation of treatment applied. The first choice of treatment was the Intra-Aortic Balloon Pump (IABP).
Materials & Methods: The study population consisted of patients admitted to the cardiac intensive care unit with acute advanced heart failure in impending or established cardiogenic shock. Patients were either on the transplant list or urgently referred for evaluation for advanced therapies and had rapidly developing, or worsening, signs and symptoms of heart failure. Patients were supported with an IABP as the first choice of temporary mechanical support and there was immediate possibility of escalation to ECMO by the hospital shock team as patient support took place in a dedicated transplant center that can offer the full range of therapies for advanced heart failure and the patients are hospitalized in conditions of high level of nursing care (ICU level III).
Renal and liver function indicators, general blood parameters, NT proBNP levels were included. Lactic acid values were recorded to assess the severity of shock. The final need to escalate support from IABP to ECMO and the outcome of the patients in relation to the specialized treatments they received, were also recorded.
Results: Hundred and four patients were studied. All of them received IABP as first therapy and the average length of stay was 13 days (3-41.25). 10.57% of them (11 patients) required additional support with ECMO. After the IABP insertion and the support, a significant percentage of patients showed clinical improvement and stabilization and the biochemical parameters almost normalized. A significant number of patients were able to complete their pre transplant screening and to proceed to either transplantation or permanent mechanical circulatory support with an LVAD. There was a statistically significant improvement of all hemodynamic parameters after the use of temporary mechanical support. Regarding patient outcome, 18 patients (17.31%) were able to be discharged from intra-aortic pump support. 11 patients (10.58%) were transplanted, while 42 patients (40.4%) proceeded to permanent mechanical support (VAD therapy).
16 patients (15.38%) ended up in the cardiac ICU. A statistically significant correlation of the outcome (death) with the value of NT-proBNP, renal function and application of renal dialysis, intubation as well as the value of 24-hour lactic acid was observed.
Conclusion: The organizational structure of a hospital seems to influence the effectiveness of certain interventions even for critically ill patients. A less aggressive initial approach such as IABP support relative to the rapid use of extracorporeal membrane oxygenation (ECMO), which is arguably a common strategy in patients with severe cardiogenic shock, may ultimately prove effective for a significant proportion of patients if applied rapidly and in high level of nursing care setting ( Level III ) .
Vigilance and immediate response to potential escalation of treatment does not exclude an initial conservative approach, on the contrary, for a significant number of patients it may prove to be satisfactory and there is a significant benefit for both the patient and the hospital as it entails fewer risks and requires fewer resources.

Health Sciences

advanced heart failure, organizational structure, CICU

No

0

Yes

201

215

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https://pergamos.lib.uoa.gr/uoa/dl/object/3330725