Shock Stages in Cardiac Surgical Patients: Implications for Post-Cardiotomy Shock and Mortality.

BACKGROUND

Risk prognostication is essential to identify patients at risk of higher mortality following cardiac surgery.

OBJECTIVES

The Society for Cardiac Angiography and Intervention (SCAI) shock construct was adapted to cardiac surgical patients to create the CS-SCAI staging and it was applied at various time points and correlated with survival.

METHODS

Retrospective analysis of Society of Thoracic Surgeons adult cardiac surgery database from January 2015 to December 2019. The focus was 30-day survival and multivariate logistic analysis was used to examine factors. CS-SCAI E indicates extracorporeal life support or biventricular devices, CS-SCAI D patients receive vasoactive(s) and a single device whereas CS-SCAI C patients have either one device or a vasoactive but not both. CS-SCAI B has heart failure, urgent surgery, or cardiopulmonary resuscitation, otherwise CS-SCAI A is assigned.

RESULTS

A total of 1,164,015 patients were included. Preoperatively 35.9%, 54.9%, 8.3%, 0.7%, and 0.2% of patients were in Stages A, B, C, D, and E, respectively, with corresponding mortality of 1.2%, 2.12%, 9.84%, 17.06%, and 42.1% (chi-square P < 0.0001). In the preoperative and postoperative setting, CS-SCAI stage was the strongest predictor of mortality. Transition to worsened CS-SCAI stage postoperatively occurred in 6,508 patients with 30-day mortality 51.6%. The strongest predictors of stage transition were cardiopulmonary bypass time, preoperative CS-SCAI stage, and aortic cross clamp time.

CONCLUSIONS

CS-SCAI facilitates risk prognostication prior to and following cardiac surgery. Transitions of stage are associated with a spectrum of high mortality and could be used to better define post-cardiotomy shock.