Critical Care Ultrasonography for Cardiogenic Shock: A Scoping Review.

OBJECTIVES

To summarize the effectiveness of critical care ultrasonography (CCUS) in adult patients with cardiogenic shock vs. standard of care without CCUS on patient-relevant outcomes.

DESIGN

We performed a scoping review across MEDLINE, Embase, CENTRAL, World Health Organization, International Clinical Trials Registry, ClinicalTrials.gov, and published and unpublished sources from inception until February 2024.

SETTING

The emergency department, ward, or ICU.

PATIENTS: We included randomized clinical trials (RCTs) and observational studies comparing CCUS to non-CCUS care in adult patients with cardiogenic shock. We included any type of ultrasound measure for the intervention in adult patients (≥ 18 yr old).

INTERVENTIONS: CCUS.

MEASUREMENTS AND MAIN

RESULTS

We included two RCTs (n = 573 patients) and one observational study (n = 30 patients). RCT data suggested that CCUS, with transesophageal echocardiography in particular, in adult patients with cardiogenic shock may shorten time to resolution of hemodynamic instability at 72 hours (subhazard ratio [SHR], 1.26; 95% CI, 1.02-1.55) but failed to influence mortality (risk difference, -0.03; 95% CI, -0.1 to 0.05), time to resolution of hemodynamic instability within 6 days (SHR, 1.20; 95% CI, 0.98-1.46), ICU length of stay (LOS; p = 0.87), hospital LOS (p = 0.91), duration of mechanical ventilation (p = 0.73), or duration of renal replacement therapy (RRT; p = 0.68).

CONCLUSIONS

In adult patients with cardiogenic shock, CCUS does not impact mortality, time to resolution of hemodynamic instability within 6 days, ICU and hospital LOS, nor mechanical ventilation or RRT duration. Notably, CCUS may hasten resolution of hemodynamic instability at 72 hours, but such evidence is limited by imprecision and indirectness.