Inclusion criteria | Exclusion criteria |
---|---|
1. Adult (age ≥ 18 years); | 1. Cardiogenic shock state with catecholamine infusion for more than 24 h; |
2. Cardiogenic shock state according to the following definition: | 2. Presence of sepsis at inclusion; |
a. Systemic arterial hypotension (SAP < 90 mmHg or MAP < 65 mmHg for 30 min) and/or low cardiac output requiring catecholamines to achieve a systolic blood pressure ≥ 90 mmHg; | 3. Cardiac arrest recovered within 7 days prior to inclusion, with at least one of the following early signs of poor prognosis: no witness, non-shockable rhythm, CAHP score > 150 [16]; |
a. Sign of hypocontractility or low cardiac output among the following: cardiac index ≤ 2.2 L/min/m2, left ventricular ejection fraction (LVEF) ≤ 40%, or VTI LVOT ≤ 18 cm, or need for catecholamines to maintain adequate cardiac index, LVEF, or VTI LVOT; | 4. Patients already on MCS before inclusion; |
b. Signs of impaired organ perfusion with at least one of the following criteria: | 5. Cardiogenic shock cause by viral myocarditis; |
i. Altered mental status | 6. Corticosteroid therapy within 4 weeks prior to inclusion; |
ii. Skin mottling | 7. Patient receiving one of the following treatments: ketoconazole, rifampicin, phenytoin, phenobarbital, cyclosporine, clarithromycin; |
iii. Oliguria (≤ 25 ml/h) | 8. Hypersensitivity to fludrocortisone or hydrocortisone; |
iv. Increased serum lactate (> 2 mmol/L) | 9. Pregnancy or breastfeeding; |
c. Pulmonary congestion or elevated left-ventricular filling pressures | 10. Privation of liberty by administrative or judicial decision; |
3. Written informed consent from the patient or proxy (if present) before inclusion or once possible when patient has been included in a context of emergency; | 11. Refusal of study participation or to pursue the study by the patient; |
4. Benefiting of coverage by the French statutory healthcare insurance system. |