Pulmonary Artery Catheter in Cardiogenic Shock Trial (PACCS)
Cardiogenic Shock, Heart Failure
About this trial
This is an interventional treatment trial for Cardiogenic Shock focused on measuring Pulmonary Artery Catheter
Eligibility Criteria
Inclusion Criteria:
- Age ≥18 years and ≤90 years
Clinical heart failure presentation and left ventricular function as follows: Either 2A or 2B must be present A. Subject has de novo acute decompensated heart failure and shock with an LVEF ≤40% OR B. Subject has acute on chronic heart failure with a documented history of a LVEF ≤40% within 6 months of admission and a current LVEF ≤40% within 24 hours of screening during the current hospitalization.
NOTE: The LVEF must be quantitatively measured as ≤ 40% by an echocardiogram within 24 hours of screening. If multiple echocardiograms have been performed within 24 hours, the most recent test must be used to qualify the patient.
Cardiogenic Shock (CS) defined by a lactate level ≥ 2.1 mmol/L and any 2 of the following parameters within 24 hours of screening:
- SBP <90 mmHg for more than 30 minutes from baseline SBP
- Requires the use of at least 1 vasopressor or inotrope
- Requires intra-aortic balloon pump (IABP) support
- Presence of congestion on exam: JVP elevated, pulmonary edema on CXR or exam, dyspnea at rest, orthopnea, bendopnea, or worsening peripheral or abdominal swelling
- Initial diagnosis of CS within 24 hours of screening at the enrolling site
- Patient or legally authorized representative provides informed consent
A HIPAA waiver for screening is requested to identify potential subjects. No recruitment materials will be given to potential subjects. No identifiable data will be retained for subjects that are determined to be ineligible
Exclusion Criteria:
- Primary etiology of shock other than systolic left heart failure including but not limited to: acute myocardial infarction, sepsis, hypovolemia, hemorrhage, severe anemia, primary RV failure, pulmonary embolism, or tamponade.
- Patient has a durable ventricular assist device or temporary mechanical circulatory support (other than IABP) or PAC prior to enrollment
- Actively listed for cardiac transplantation (Status 7 patients are eligible for the trial)
- Patient transferred from another facility with a diagnosis of cardiogenic shock
- Any known co-morbidity other than heart failure with anticipated survival < 6 months
- Pre-enrollment labs (any of the following): International Normalized Ratio (INR) > 3, Platelet count < 50k, Hemoglobin < 7
- Refractory or recurrent cardiac arrest (>1 episode requiring defibrillation or cardiopulmonary resuscitation) within 24 hours prior to screening
- DNR/ DNI status
- Pregnancy, child-birth within 6 months, or lactation
- Active infection documented by persistent fever (Temp > 38.4oC within 24 hours of screening) or confirmed bacteremia
- Implantation of PPM or ICD within past 3 months
- Mechanical complication of AMI (ie VSD, papillary muscle rupture, flail mitral regurgitation, free wall rupture)
- Anoxic brain injury
- On renal replacement therapy prior to enrollment
- Cardiac surgery within 3 months of current admission
- Severe aortic, pulmonic, tricuspid stenosis or acute structural mitral regurgitation or infective endocarditis
- History of cardiac amyloid
- Congenital heart disease excluding the presence of a bicuspid aortic valve
- Planned cardiac surgery during admission
- World Health Organization (WHO) Group I, III, IV, or V pulmonary hypertension
- Any known contraindication to PAC placement
- Participation in the active treatment or follow-up phase of another clinical study of an investigational drug or device that has not reached its primary endpoint
- Any medical or psychiatric condition such as dementia, alcoholism, or substance abuse which may preclude informed consent or interfere with any of the study procedures, including follow-up
- Prior stroke with any permanent neurologic deficit or any prior intracranial hemorrhage or any prior subdural hematoma or known intracranial pathology pre-disposing to intracranial bleeding, such as an arteriovenous malformation or mass
- Subject has previously hospitalized for COVID-19 unless he/she has been discharged and asymptomatic for ≥4 weeks
- Subject is COVID-19 PCR/antigen positive within the prior 4 weeks
- Subject belongs to a vulnerable population [defined as individuals with mental disability, persons in nursing homes, impoverished persons, homeless persons, nomads, refugees and those permanently incapable of giving informed consent; vulnerable populations also may include members of a group with a hierarchical structure such as university students, subordinate hospital and laboratory personnel, members of the armed forces and persons kept in detention]
Sites / Locations
- Tufts Medical Center
Arms of the Study
Arm 1
Arm 2
Experimental
No Intervention
Early Pulmonary Artery Catheter
No or delayed Pulmonary Artery Catheter
If you are in the experimental group a PAC will be placed within 6 hours of randomization and within 24 hours of presentation with ADHF-CS.
If you are in the control group, a PAC will not be placed during hospitalization or may be placed 48 hours after randomization into the study. Placement of a PAC within 48 hours is only permitted for emergencies.