Clareo Health | Routine Microaxial Heart Pump Support and Protocolized Pulmonary Artery Catheter Monitoring Versus Standard Care in Heart Attack-Related Cardiogenic Shock
Routine Microaxial Heart Pump Support and Protocolized Pulmonary Artery Catheter Monitoring Versus Standard Care in Heart Attack-Related Cardiogenic Shock
Cardiogenic shock complicating AMI (STEMI or NSTEMI) plus obligatory all 4 of these:
1. Planned immediate angiography and revascularization (preferred PCI)
2. Systolic blood pressure \<100 mmHg or catecholamines required to maintain pressure \>90 mmHg during systole
3. Arterial lactate \>2.0 mmol/L
4. Echocardiogram with LVEF \<40% or left ventricular outflow tract velocity time integral (LVOT-VTI) ≤12 cm
You may not be if
1. Age \<18 and \>80 years
2. Shock duration \>12 hours
3. Other causes of shock (hypovolemia, sepsis, pulmonary embolism or anaphylaxis).
4. Shock due to mechanical complication of AMI
5. Witnessed out-of-hospital cardiac arrest (OHCA) with chest compression \>10 min in total (cardiac arrest occurring in ambulance or after hospital arrival is NOT an exclusion criterion and witnessed OHCA with duration of chest compression \<10 min are also eligible)
6. After 390 included patients with OHCA, any OHCA will be an exclusion criterion
7. Any unwitnessed OHCA
8. Refractory cardiac arrest with ongoing chest compression
9. Evidence of severe right ventricular failure
10. Severe aorta valve regurgitation/stenosis
11. Severe peripheral arterial obstructive disease precluding mAFP placement
12. Abnormalities of the aorta precluding mAFP device placement
13. Presence of a mechanical aortic valve prosthesis
14. Left ventricular thrombus
15. Infective endocarditis
16. Life expectancy \<1 year due to comorbidities
17. Mental disorder or language barrier that preclude informed consent
