Thomas möller skurup
› thomas+möller › skivarp › person. A, VIS. B, VIS for inotropes. C, VIS for vasopressors. Changes were measured during intensive care after infarct-related cardiogenic shock in patients randomized to microaxial flow pump MAFP or Standard of Care Standard. ICU indicates intensive care unit. Doses were scaled to a z score to enable visual comparisons between groups and time points.
The z score: gray depicts mean, red SD above mean, blue SD below mean.
The colors can be compared between the 2 treatments standard of care and MAFP and between different times but not between the different groups of vasoactive drugs. JAMA Cardiol. Published online October 27, Question Does the use of a microaxial flow pump MAFP reduce the need for pharmacological circulatory support and what are the effects on hemodynamics and lactate clearance in patients with ST-elevation myocardial infarction—induced cardiogenic shock STEMI-CS?
Moeller football team defeats St. Edward, unofficially earns top seed in Region 4
Findings In this substudy of the Danish-German DanGer Shock randomized clinical trial involving patients with STEMI-CS admitted to the intensive care unit, the MAFP group had significantly lower vasoactive-inotropic scores during the first 12 hours compared with the standard-care group, without compromising hemodynamics. In addition, MAFP was associated with significantly faster arterial lactate clearance compared with standard of care.
Understanding the impact on hemodynamic stability over time is crucial for optimizing patient treatment. Design, Setting, and Participants This was a substudy of the Danish-German DanGer Shock trial, an international, multicenter, open-label randomized clinical trial. Patients from 14 heart centers across Denmark, Germany, and the UK were enrolled. Of the enrolled patients, after exclusions from death in the catheterization laboratory or immediately on intensive care unit ICU admission, the remaining patients had serial recordings of hemodynamics, arterial lactate, and use of vasoactive drugs.
Patients who were in comas after cardiac arrest and patients with mechanical complications or right ventricular failure were excluded.
25 jaar Sedus en Klöber – Interview met Thomas Möller
Data were analyzed from May to September Interventions MAFP and standard of care or standard of care alone. Main Outcomes and Measures Hemodynamic status in terms of heart rate and blood pressure, metabolic status in terms of arterial lactate concentration, and vasoactive-inotropic score VIS. The clinical events during the first 72 hours were as follows: death from all causes, escalation of mechanical circulatory support, and discharge alive from the ICU.
Baseline characteristics were balanced. There was no difference in heart rate between groups, and mean arterial pressure was above the treatment target of 65 mm Hg in both groups but was achieved with a lower VIS in the MAFP group. No difference in arterial lactate level was found between groups at randomization, but on arrival to the ICU, the MAFP group had significantly lower arterial lactate levels compared with the standard-care group mean difference, 1.
Trial Registration ClinicalTrials. This further exacerbates myocardial ischemia and results in end-organ hypoperfusion. Although revascularization of the occluded artery is crucial for improving outcomes, 4 it does not necessarily restore cardiac function and organ perfusion immediately. The use of vasoactive agents and mechanical circulatory support to reestablish organ perfusion is common; however, evidence supporting their efficacy in enhancing survival remains limited.
The trial investigators eAppendixes 1 and 2 in Supplement 1 , design, and primary results have been described elsewhere. Data on participant race and ethnicity were not recorded. The inclusion criteria for the trial have been previously described. Main exclusion criteria were comatose status after out-of-hospital cardiac arrest, mechanical complication to STEMI, and right ventricular failure.
All patients received standard treatment with immediate revascularization and intensive care with pharmacological circulatory support. In general, an MAP greater than or equal to 65 mm Hg was targeted. Recommendations on individual drugs and other treatment targets were specified by the protocol eMethods 2 in Supplement 1. Escalation to venoarterial extracorporeal membrane oxygenation VA-ECMO was based on decision by the treating shock team according to recommendations in the protocol eMethods 1 and 2 in Supplement 1.
It was recommended that the MAFP run at highest performance level without causing suction and continue supporting for at least 48 hours unless complications occurred. Further treatment was according to protocol and international consensus 12 , 14 and maintained by the physician in charge with use of a multidisciplinary team decision on de-escalation or escalation as described in the protocol eMethods 1 and 2 in Supplement 1.
Data included arterial lactate level, MAP, heart rate HR , and dosage of norepinephrine, epinephrine, dopamine, dobutamine, milrinone, and levosimendan. To quantify the amount of vasoactive and inotropic support a patient was receiving at the predefined time points, the VIS was calculated by assigning weighted values to different medications to assess the summed cardiovascular support need.
To provide a more granular description of pharmacological circulatory support, the VIS was subdivided into vasopressors as follows:. In addition, we sought to assess the hemodynamic, metabolic status relative to cardiovascular support needs in a more holistic vasoactive-hemodynamic score VHS. This was developed for the purpose of this study and prespecified before unblinding.
The calculation of the VHS is described in eFigure 2 in Supplement 1 where a higher score indicated more severe hemodynamic compromise relative to degree of pharmacological circulatory support.