CONGRESS ABSTRACT

Background:Cardiogenic shock (CS) management is challenging due to the heterogeneity of clinical presentations, complex hemodynamic perturbations and several complications.Therefore a multidisciplinary shock team and dedicated intensive cardiac care unit (ICCU) are necessary to treat these patients (pts). Purpose:To assess clinical features and outcome of CS pts treated in a ICCU of a single tertiary center,inserted in a regional network for CS. Methods:We prospectively analyzed a cohort of CS pts admitted in an ICCU of a tertiary center from October 2020 to October 2024.This ICCU provides cardiac replacement therapy and operates as part of a regional system for advanced heart failure and CS.Early referrals, collaborative multidisciplinary discussions for pts transfers, and shared protocols are common to all network’s centers. Results:We enrolled 145 pts with CS admitted in our ICCU.Mean age of the population was 60.9 years,80.6% were males.CS etiology was ACS in 46.2% of pts,acute decompensated heart failure in 47.6%,other etiologies in 6.2%.Ninty-one pts (62.7%) were transferred from other ICU/ICCU of the regional network for CS.These pts were supported by mechanical circulatory support (58.6% IABP, 13.7% microaxial pump, 20.0% VA-ECMO).The mechanical supports were selected and re-assessed by a multidisciplinary team,considering data from a multiparametric monitoring,and according to an escalation and de-escalation strategy.Sixty-eight pts needed mechanical ventilation, 29 continuous replacement therapy.Despite including a high-risk population, with a significant proportion of pts in SCAI stages D (36.5%) and E (12.4%) and phenotypes of the cardiogenic shock working group type II (40.0%) and type III (22.1%), the overall outcomes were favorable.The successful outcome, comprehensive of pts discharged from hospital or treated with a cardiac replacement therapy, were obtained in 80.6% of the cohort: 23 pts were treated with heart transplantation and 9 with LVAD implantation.The in-hospital mortality rate was 26.2%.[Table 1, Figure 1]. Conclusions:Despite the severity of CS population this study showed lower mortality rate than that reported in literature.A structured network for CS with early referral to ICCU and a multidisciplinary team for evaluation of escalation and de-escalation of mechanical circulatory support may play a role on outcome.