Personalisation of Mean Arterial Pressure in Adult Patients With Cardiogenic Shock

Summary

Cardiogenic shock is a life-threatening condition characterized by inadequate cardiac output, leading to organ hypoperfusion and high mortality. Maintaining mean arterial pressure (MAP) is crucial, but standard targets may be insufficient due to venous congestion. Central venous pressure (CVP) can help assess effective perfusion pressure. This study investigates whether a personalized MAP target adjusted by CVP improves organ function and survival compared to standard MAP management.

Eligibility

Inclusion Criteria:

* Aged ≥18 years
* Cardiogenic shock state, according to the consensus definition,
* SCAI (Society for Cardiovascular Angiography and Interventions) classification ≥ C
* Consent from the patient or close relative / trusted person or emergency inclusion procedure
* Benefiting fromciary of a social security scheme

Exclusion Criteria:

* Catecholamine infusion for more than 24 consecutive hours;
* CVP \< 5 mm Hg at inclusion;
* MAP \> 70 mmHg at inclusion;
* Chronic kidney disease stage G4 (defined by an eGFR between 15-29 ml/min/1.73 m²) or G5 (defined by an eGFR less than 15 ml/min/1.73 m²) according to the KDIGO CKD classification at inclusion;
* Chronic dialysis or presence of renal replacement therapy criteria at inclusion ;
* Recovered cardiopulmonary arrest within 7 days prior to inclusion;
* Patient already on mechanical circulatory support at inclusion before enrollment (patients who receive support after inclusion will not be excluded);
* Primary diagnosis of tamponade, pulmonary embolism, or septic shock;
* Hypersensitivity to norepinephrine tartrate or to any of the following excipients: sodium chloride, hydrochloric acid or sodium hydroxide water for injectable preparations;
* Absence of central venous access;
* Known pregnancy or current breastfeeding;
* Under legal guardianship, curatorship, or judicial protection.

Conditions2

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