Cardiogenic Shock: Recent Developments and Significant Knowledge Gaps

Overview

Journal Curr Treat Options Cardiovasc Med

Specialty Cardiology & Vascular Diseases

Date 2018 Feb 26

PMID 29478105

Citations 1

Authors

Hiren Patel

Haider Nazeer

Neil Yager

Joshua Schulman-Marcus

Affiliations

Soon will be listed here.

Abstract

Purpose Of Review: Patients with cardiogenic shock (CS) continue to have high rates of morbidity and mortality. We aimed to describe current principles in the management of CS including coronary revascularization, medical management, mechanical circulatory support, and supportive care.

Recent Findings: Revascularization is still recommended, but trials have not found a benefit in the revascularization of nonculprit artery lesions. New mechanical circulatory support options are available, but optimal use remains uncertain. Overall improvement in outcomes appears to have plateaued. There remain substantial knowledge gaps about the management of CS. The ideal timing and selection criteria for mechanical support remain under-developed. There has been little systematic study to inform medical management or supportive care of this patient population. A more expansive research focus is necessary to improve the care of CS.

Citing Articles

Inter-hospital transfer of extracorporeal membrane oxygenation-assisted patients: the hub and spoke network.

Morshuis M, Bruenger F, Becker T, Kempa-Haupt A, Kizner L, Al-Khalil R Ann Cardiothorac Surg. 2019; 8(1):62-65.

PMID: 30854313 PMC: 6379188. DOI: 10.21037/acs.2018.12.03.

References

Jakob S, Ruokonen E, Grounds R, Sarapohja T, Garratt C, Pocock S . Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. JAMA. 2012; 307(11):1151-60. DOI: 10.1001/jama.2012.304. View

Kapur N, Esposito M, Bader Y, Morine K, Kiernan M, Pham D . Mechanical Circulatory Support Devices for Acute Right Ventricular Failure. Circulation. 2017; 136(3):314-326. DOI: 10.1161/CIRCULATIONAHA.116.025290. View

Johansson P, Stensballe J, Ostrowski S . Shock induced endotheliopathy (SHINE) in acute critical illness - a unifying pathophysiologic mechanism. Crit Care. 2017; 21(1):25. PMC: 5299749. DOI: 10.1186/s13054-017-1605-5. View

Harjola V, Lassus J, Sionis A, Kober L, Tarvasmaki T, Spinar J . Clinical picture and risk prediction of short-term mortality in cardiogenic shock. Eur J Heart Fail. 2015; 17(5):501-9. DOI: 10.1002/ejhf.260. View

Unverzagt S, Wachsmuth L, Hirsch K, Thiele H, Buerke M, Haerting J . Inotropic agents and vasodilator strategies for acute myocardial infarction complicated by cardiogenic shock or low cardiac output syndrome. Cochrane Database Syst Rev. 2014; (1):CD009669. DOI: 10.1002/14651858.CD009669.pub2. View

McPherson J, Wagner C, Boehm L, Hall J, Johnson D, Miller L . Delirium in the cardiovascular ICU: exploring modifiable risk factors. Crit Care Med. 2012; 41(2):405-13. PMC: 3557701. DOI: 10.1097/CCM.0b013e31826ab49b. View

De Backer D, Biston P, Devriendt J, Madl C, Chochrad D, Aldecoa C . Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med. 2010; 362(9):779-89. DOI: 10.1056/NEJMoa0907118. View

Barr J, Fraser G, Puntillo K, Wesley Ely E, Gelinas C, Dasta J . Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2012; 41(1):263-306. DOI: 10.1097/CCM.0b013e3182783b72. View

Hochman J, Sleeper L, WEBB J, Sanborn T, White H, Talley J . Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock. N Engl J Med. 1999; 341(9):625-34. DOI: 10.1056/NEJM199908263410901. View

10.

Pandharipande P, Pun B, Herr D, Maze M, Girard T, Miller R . Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA. 2007; 298(22):2644-53. DOI: 10.1001/jama.298.22.2644. View

11.

de Waha S, Jobs A, Eitel I, Poss J, Stiermaier T, Meyer-Saraei R . Multivessel versus culprit lesion only percutaneous coronary intervention in cardiogenic shock complicating acute myocardial infarction: A systematic review and meta-analysis. Eur Heart J Acute Cardiovasc Care. 2017; 7(1):28-37. DOI: 10.1177/2048872617719640. View

12.

Goldberg R, Spencer F, Gore J, Lessard D, Yarzebski J . Thirty-year trends (1975 to 2005) in the magnitude of, management of, and hospital death rates associated with cardiogenic shock in patients with acute myocardial infarction: a population-based perspective. Circulation. 2009; 119(9):1211-9. PMC: 2730832. DOI: 10.1161/CIRCULATIONAHA.108.814947. View

13.

Mehta S, Cook D, Devlin J, Skrobik Y, Meade M, Fergusson D . Prevalence, risk factors, and outcomes of delirium in mechanically ventilated adults. Crit Care Med. 2014; 43(3):557-66. DOI: 10.1097/CCM.0000000000000727. View

14.

Thiele H, Zeymer U, Neumann F, Ferenc M, Olbrich H, Hausleiter J . Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. Lancet. 2013; 382(9905):1638-45. DOI: 10.1016/S0140-6736(13)61783-3. View

15.

Crossman D . The pathophysiology of myocardial ischaemia. Heart. 2004; 90(5):576-80. PMC: 1768241. DOI: 10.1136/hrt.2003.029017. View

16.

Webb J, Lowe A, Sanborn T, White H, Sleeper L, Carere R . Percutaneous coronary intervention for cardiogenic shock in the SHOCK trial. J Am Coll Cardiol. 2003; 42(8):1380-6. DOI: 10.1016/s0735-1097(03)01050-7. View

17.

Wesley Ely E, Shintani A, Truman B, Speroff T, Gordon S, Harrell Jr F . Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA. 2004; 291(14):1753-62. DOI: 10.1001/jama.291.14.1753. View

18.

Furer A, Wessler J, Burkhoff D . Hemodynamics of Cardiogenic Shock. Interv Cardiol Clin. 2017; 6(3):359-371. DOI: 10.1016/j.iccl.2017.03.006. View

19.

Kolte D, Khera S, Dabhadkar K, Agarwal S, Aronow W, Timmermans R . Trends in Coronary Angiography, Revascularization, and Outcomes of Cardiogenic Shock Complicating Non-ST-Elevation Myocardial Infarction. Am J Cardiol. 2015; 117(1):1-9. DOI: 10.1016/j.amjcard.2015.10.006. View

20.

Hochman J, Sleeper L, Webb J, Dzavik V, Buller C, Aylward P . Early revascularization and long-term survival in cardiogenic shock complicating acute myocardial infarction. JAMA. 2006; 295(21):2511-5. PMC: 1782030. DOI: 10.1001/jama.295.21.2511. View