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©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
Application of pulse index continuous cardiac output system in elderly patients with acute myocardial infarction complicated by cardiogenic shock: A prospective randomized study
Yuan-Bo Zhang, Zhi-Zhong Zhang, Jun-Xia Li, Yu-Hong Wang, Wei-Lin Zhang, Xin-Li Tian, Yun-Feng Han, Meng Yang, Yu Liu
Yuan-Bo Zhang, Jun-Xia Li, Xin-Li Tian, Yun-Feng Han, Meng Yang, Department of Cardiovascular Medicine, The Seventh Medical Center, General Hospital of the Chinese PLA, Beijing 100700, China
Zhi-Zhong Zhang, Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Yu-Hong Wang, Department of Emergency Medicine, The Seventh Medical Center, General Hospital of Chinese PLA, Beijing 100700, China
Wei-Lin Zhang, Institute of Zoology, Chinese Academy of Sciences, Beijing 100101, China
Yu Liu, Department of Emergency Medicine, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing 100700, China
Author contributions: Zhang YB and Zhang ZZ contributed equally to this work; Zhang YB and Li JX obtained and analyzed the study; Zhang YB and Zhang ZZ wrote the paper; Wang YH, Zhang WL, Tian XL and Yang M interpreted the patient data; Zhang YB, Liu Y and Han YF revised the manuscript; All authors read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the General Hospital of Chinese PLA Institutional Review Board.
Clinical trial registration statement: This study is registered at Chinese Trial Registry (http://www.chictr.org.cn/index.aspx). The registration identification number is ChiCTR1000022691.
Informed consent statement: Written informed consent form was provided by family members of the patients.
Conflict-of-interest statement: The authors of this manuscript have no conflicts of interest to disclose.
Data sharing statement: There is no additional data available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yu Liu, MD, Associate Professor, Department of Emergency Medicine, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, No.5, Haiyuncang, Dongcheng District, Beijing 100700, China. davidliuyu@126.com
Telephone: +86-10-84011792 Fax: +86-10-84011792
Received: February 28, 2019
Peer-review started: March 4, 2019
First decision: April 18, 2019
Revised: April 26, 2019
Accepted: May 1, 2019
Article in press: May 2, 2019
Published online: June 6, 2019
BACKGROUND
Cardiogenic shock (CS) secondary to acute myocardial infarction (AMI) complicates management of the condition, and often leads to poor prognosis. Prompt and accurate monitoring of cardiovascular and accompanying hemodynamic changes is crucial in achieving adequate management of the condition. Advances in technology has availed procedures such as pulse index continuous cardiac output (PiCCO), which can offer precise monitoring of cardiovascular functions and hemodynamic parameters. In this study, PiCCO is evaluated for its potential utility in improving management and clinical outcomes among elderly patients with AMI complicated by CS.
AIM
To assess whether use of the PiCCO system can improve clinical outcomes in elderly patients with AMI complicated by CS.
METHODS
Patients from emergency intensive care units (EICU) or coronary care units (CCU) were randomized to receive PiCCO monitoring or not. The APACHE II score, SOFA score, hs-TnI, NT-proBNP, PaO2/FiO2 ratio and lactate levels on day 1, 3 and 7 after treatment were compared. The infusion and urine volume at 0-24 h, 24-48 h and 48-72 h were recorded, as were the cardiac index (CI), extravascular lung water index (EVLWI), intrathoracic blood volume index (ITBVI) and global end diastolic volume index (GEDVI) at similar time intervals.
RESULTS
Sixty patients with AMI complicated by CS were included in the study. The PiCCO group had a significantly lower APACHE II score, SOFA score, hs-TnI and NT-proBNP levels on day 1, 3 and 7 after treatment. The infusion and urine volume during 0-24 h in the PiCCO group were significantly greater, and this group also showed significantly higher ADL scores. Furthermore, the PiCCO group spent lesser days on vasoactive agents, mechanical ventilation, and had a reduced length of stay in EICU/CCU. Additionally, the CI was significantly higher at 48 h and 72 h in the PiCCO group compared with that at 24 h, and the EVLWI, ITBVI and GEDVI were significantly decreased at 48 h and 72 h.
CONCLUSION
Applying the PiCCO system could improve the clinical outcomes of elderly patients with AMI complicated by CS.
Core tip: Previous studies investigating the usefulness of the pulse index continuous cardiac output (PiCCO) system have mainly focused on patients with septic shock, acute respiratory distress syndrome and necrotizing pancreatitis. There are few reported studies conducted in elderly patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). Therefore, the aim of the present randomized controlled trial was to assess whether the application of PiCCO could improve clinical outcomes for elderly patients with AMI complicated by CS.
