New Report Published Compares Hemodynamics of Cardiac Shock in COVID19 Patients
What You Need to Know
A new report by cardiologists from the Heart & Vascular Hospital at Hackensack University Medical Center that compares the hemodynamics of cardiac shock in patients with COVID-19 during the first versus the second wave of the COVID-19 pandemic was published in JACC: Journal of the American College of Cardiology.1
During the first wave of the pandemic, a substantial proportion of patients with COVID-19 -- 43 percent -- had shock and a low cardiac output but with a preserved ejection fraction suggesting underfilling of the left ventricle.
The proportion of these patients was smaller in the second phase of the pandemic – 29 percent.
The Hackensack Meridian cardiologists characterized the hemodynamic profiles of patients with COVID-19 and shock, using echocardiography in the first wave of the pandemic; March 2020 to August 2020.
The report compares the distribution of patients using these hemodynamic profiles determined echocardiographically to the second wave of the pandemic; September 2020 to March 2021.
Study Methods
In 327 patients with COVID-19 and cardiac shock requiring vasopressors who had an echocardiogram, ejection fraction and stroke volume were measured.
Results
There were 155 patients in wave one and 172 in wave two. Mean age: 66.9±12.6 vs 63.9±12.9, EF 59.9±12.8 vs 56.4±9.3; CI 2.4±0.9 vs 2.7±0.9, all p=NS. Hospital mortality was 77 percent and 83 percent in wave one and wave two respectively (p=0.07). A smaller proportion of patients in wave two with a preserved EF had a low CI (45/153, 29%) than in wave one (55/128, 43%) (p=0.03). Mean PEEP did not differ in the preserved EF low CI group between W1 and W2 (11.3 vs 11.6 cmH2O, p=0.8). This result suggests that fluid therapy may have been more aggressive in wave 2 than wave 1 resulting in higher cardiac output.
For information about Hackensack Meridian Health’s cardiovascular services, visit https://www.hackensackmeridianhealth.org/services/cardiov