effect at 3 months of early empagliflozin initiation in cardiogenic shock patients on mortality, rehospitalization, left ventricular ejection fraction and renal function.

Conditions: Cardiogenic Shock

Summary: long term prognosis of cardiogenic shock is related to the resolution of haemodynamic failure, associated visceral failure and the recovery of an adequate myocardial function. in the immediate aftermath of cardiogenic shock, after catecholamines weaning, there are no recommendations on cardiovascular treatments that would improve this long term prognosis. indeed, the standard cardiovascular treatments such as inhibitors of the renin-angiotensin and aldosterone system and beta-blockers have hypotensive and negative inotropic effects and may worsen the renal function. in practice, given their side effects, they are not prescribed in the immediate aftermath of cardiogenic shock. sodium-glucose co-transporter 2 (isglt2) inhibitors are now an integral part of the drug management of chronic heart failure and the empulse-hf trial has just demonstrated a benefit in acute heart failure (pmid: 35228754). several pivotal clinical trials have demonstrated a significant effect of isglt2 on the survival and the risk of re hospitalisation for heart failure (pmid: 32865377, 31535829, 33200892). our hypothesis is that, in patients in cardiogenic shock, early treatment with empaglifozin in addition to the standard management could reduce mortality and morbidity (death, transplantation/lvad and rehospitalisation for heart failure) and improve myocardial function at 12 weeks, compared with standard management alone.


Eligibility criteria:
inclusion criteria: * adult patients hospitalized in critical cardiac unit care or intensive care unit for a cardiogenic shock * patient on catecholamine for more than 12 hours and less than 5 days. exclusion criteria: * gfr\< 20 ml/min/1.73m2. * chronic dialysis. * patient on sglt2 inhibitors prior to admission to icu or ccu. * known allergy to sglt2 inhibitors or to any of its excipients (in particular, patients with hereditary disorders of galactose intolerance, total lactase deficiency or glucose or galactose malabsorption syndrome) * patients on lithium. * patient in shock for another cause or moribund (saps2\> 90). * specific cardiogenic shock context: 1. cardiac transplant patient or on transplant list. 2. peripartum, adrenergic, valvular, restrictive, post embolic heart disease. 3. caused by a conduction/rhythm disorder of non-ischemic etiology. 4. related to cardiotropic drug intoxication. 5. secondary to a cardiocirculatory arrest with more than 25 min of "low flow" or more than 5 min of "no flow" before recovery of a stable cardiac activity. * patient undergoing va-ecmo at admission (before or in whom implantation is imminent (less than 3 hours)). * women of childbearing age without effective contraception. * person referred to in articles 10, 31, 32, 33 and 34 of eu regulation 536/2014 (pregnant woman, parturient or breastfeeding mother, minor (not emancipated), adult person subject to a legal protection measure (guardianship, curatorship, safeguard of justice))

Keywords: heart failure acute heart failure cardiogenic shock sglt2 inhibitor mortality