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You are here:  Home > Cardiac Assist > Problem: Cardiogenic Shock
Problem: Cardiogenic Shock
  • Leading cause of death in patients hospitalized with AMI2
  • 50 – 80% mortality1
  • > 75% occurrence – post hospital admission1
  • 5% – 10% of all AMIs1
    • AMI Patients present everywhere
    • 29% in Tertiary Care Centers
    • 46% in Community Hospitals
    • 25% die before admission

Solution: Counterpulsation. An optimal treatment for Cariogenic Shock

Counterpulsation therapy is a CLASS I indication for patients in “cardiogenic shock, not quickly reversed with pharmacological therapy...”
(1999 Update: ACC/AHA Guideline) 

“Optimal treatment [of cardiogenic shock patients] nowadays should include early angiography, intra-aortic balloon pumping, primary angioplasty/stenting or bypass surgery..In smaller hospitals, pharmacological reperfusion should be given as soon as possible, followed by rapid transfer to a tertiary care centre, if possible after insertion of a balloon pump.”
(Dens & Van De Werf, Eur. Heart J, 12/00)3

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“In hospitals without direct angioplasty capabilities, stabilization with IABP and thrombolysis followed by transfer to a tertiary care facility may be the best management option.”
(Hollenberg, et al, Ann. Intern. Med, 1999)1

Thrombolysis And Counterpulsation Improves Cardiogenic Shock Survival (TACTICS, Duke Study)6
“ ...we conclude that IABP in conjunction with thrombolysis is associated with:

  • Few vascular and hemorrhagic complications
  • A reduction in mortality that is consistent with observational studies using IABP in cardiogenic shock” (Ohman, et al,...)

A marked reduction in mortality The use of IABP in patients with AMI complicated by cardiogenic shock is associated with a marked reduction in mortality when used in combination with thrombolytic therapy…
(Baron, JACC, 2/98)4


Marked international variation in cardiogenic shock survival and IABP use supports increased IABP utilization. (Hudson, et al, GUSTO I & III trials)5 

1. Cardiogenic Shock, Hollenberg, et al, Ann. Intern. Med, 1999
2. Lack of progress in cardiogenic shock: lessons from the GUSTO trials, Menon et al, Eur. Heart J, 12/00
3. Cardiogenic shock: a call for aggressiveness, Dens & Van De Werf, Eur. Heart J, 12/00
4. Use of IABC in patients with AMI complicated by cardiogenic shock, Barron, JACC, 2/98
5. Cardiogenic shock survival and use of in IABC: result from GUSTO I and III trials, Hudson, et al, slide series
6. Counterpulsation and thrombolysis together improve survival after cardiogenic shock – the TACTICS results, Ohman, et al. ESC, 8/00

 

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