Management of Post-cardiotomy Shock

Overview

Journal US Cardiol

Date 2024 Nov 4

PMID 39494414

Authors

Eric J Hall

Alexander I Papolos

P Elliott Miller

Christopher F Barnett

Benjamin B Kenigsberg

Affiliations

Soon will be listed here.

Abstract

Patients undergoing cardiac surgery experience significant physiologic derangements that place them at risk for multiple shock phenotypes. Any combination of cardiogenic, obstructive, hemorrhagic, or vasoplegic shock occurs commonly in post-cardiotomy patients. The approach to the diagnosis and management of these shock states has many facets that are distinct compared to non-surgical cardiac intensive care unit patients. Additionally, the approach to and associated outcomes of cardiac arrest in the post-cardiotomy population are uniquely characterized by emergent bedside resternotomy if the circulation is not immediately restored. This review focuses on the unique aspects of the diagnosis and management of post-cardiotomy shock.

References

Acharya D, Torabi M, Borgstrom M, Rajapreyar I, Lee K, Kern K . Extracorporeal Membrane Oxygenation in Myocardial Infarction Complicated by Cardiogenic Shock: Analysis of the ELSO Registry. J Am Coll Cardiol. 2020; 76(8):1001-1002. DOI: 10.1016/j.jacc.2020.06.062. View

Cecconi M, De Backer D, Antonelli M, Beale R, Bakker J, Hofer C . Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med. 2014; 40(12):1795-815. PMC: 4239778. DOI: 10.1007/s00134-014-3525-z. View

HALL T, Brevetti G, Skoultchi A, Sines J, Gregory P, Spotnitz A . Re-exploration for hemorrhage following open heart surgery differentiation on the causes of bleeding and the impact on patient outcomes. Ann Thorac Cardiovasc Surg. 2002; 7(6):352-7. View

Korabathina R, Heffernan K, Paruchuri V, Patel A, Mudd J, Prutkin J . The pulmonary artery pulsatility index identifies severe right ventricular dysfunction in acute inferior myocardial infarction. Catheter Cardiovasc Interv. 2011; 80(4):593-600. DOI: 10.1002/ccd.23309. View

Argenziano M, Chen J, Choudhri A, Cullinane S, Garfein E, Weinberg A . Management of vasodilatory shock after cardiac surgery: identification of predisposing factors and use of a novel pressor agent. J Thorac Cardiovasc Surg. 1998; 116(6):973-80. DOI: 10.1016/S0022-5223(98)70049-2. View

Levy B, Clere-Jehl R, Legras A, Morichau-Beauchant T, Leone M, Frederique G . Epinephrine Versus Norepinephrine for Cardiogenic Shock After Acute Myocardial Infarction. J Am Coll Cardiol. 2018; 72(2):173-182. DOI: 10.1016/j.jacc.2018.04.051. View

Fiaccadori E, Vezzani A, Coffrini E, Guariglia A, Ronda N, Tortorella G . Cell metabolism in patients undergoing major valvular heart surgery: relationship with intra and postoperative hemodynamics, oxygen transport, and oxygen utilization patterns. Crit Care Med. 1989; 17(12):1286-92. DOI: 10.1097/00003246-198912000-00008. View

Chow J, Abuelkasem E, Sankova S, Henderson R, Mazzeffi M, Tanaka K . Reversal of Vasodilatory Shock: Current Perspectives on Conventional, Rescue, and Emerging Vasoactive Agents for the Treatment of Shock. Anesth Analg. 2019; 130(1):15-30. DOI: 10.1213/ANE.0000000000004343. View

Skubas N, Callum J, Bathla A, Keshavarz H, Fergusson D, Wu B . Intravenous albumin in cardiac and vascular surgery: a systematic review and meta-analysis. Br J Anaesth. 2023; 132(2):237-250. DOI: 10.1016/j.bja.2023.11.009. View

10.

Feneck R, Sherry K, Withington P . Comparison of the hemodynamic effects of milrinone with dobutamine in patients after cardiac surgery. J Cardiothorac Vasc Anesth. 2001; 15(3):306-15. DOI: 10.1053/jcan.2001.23274. View

11.

Moller J, Engstrom T, Jensen L, Eiskjaer H, Mangner N, Polzin A . Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock. N Engl J Med. 2024; 390(15):1382-1393. DOI: 10.1056/NEJMoa2312572. View

12.

Levin M, Lin H, Castillo J, Adams D, Reich D, Fischer G . Early on-cardiopulmonary bypass hypotension and other factors associated with vasoplegic syndrome. Circulation. 2009; 120(17):1664-71. DOI: 10.1161/CIRCULATIONAHA.108.814533. View

13.

Serraino G, Marsico R, Musolino G, Ventura V, Gulletta E, Sante P . Pulsatile cardiopulmonary bypass with intra-aortic balloon pump improves organ function and reduces endothelial activation. Circ J. 2012; 76(5):1121-9. DOI: 10.1253/circj.cj-11-1027. View

14.

Peretto G, Durante A, Limite L, Cianflone D . Postoperative arrhythmias after cardiac surgery: incidence, risk factors, and therapeutic management. Cardiol Res Pract. 2014; 2014:615987. PMC: 3912619. DOI: 10.1155/2014/615987. View

15.

Kurlansky P, OBrien S, Vassileva C, Lobdell K, Edwards F, Jacobs J . Failure to Rescue: A New Society of Thoracic Surgeons Quality Metric for Cardiac Surgery. Ann Thorac Surg. 2021; 113(6):1935-1942. DOI: 10.1016/j.athoracsur.2021.06.025. View

16.

Shaefi S, Mittel A, Klick J, Evans A, Ivascu N, Gutsche J . Vasoplegia After Cardiovascular Procedures-Pathophysiology and Targeted Therapy. J Cardiothorac Vasc Anesth. 2017; 32(2):1013-1022. DOI: 10.1053/j.jvca.2017.10.032. View

17.

Mehta R, Sheng S, OBrien S, Grover F, Gammie J, Ferguson T . Reoperation for bleeding in patients undergoing coronary artery bypass surgery: incidence, risk factors, time trends, and outcomes. Circ Cardiovasc Qual Outcomes. 2009; 2(6):583-90. DOI: 10.1161/CIRCOUTCOMES.109.858811. View

18.

Algarni K, Maganti M, Yau T . Predictors of low cardiac output syndrome after isolated coronary artery bypass surgery: trends over 20 years. Ann Thorac Surg. 2011; 92(5):1678-84. DOI: 10.1016/j.athoracsur.2011.06.017. View

19.

Pesonen E, Vlasov H, Suojaranta R, Hiippala S, Schramko A, Wilkman E . Effect of 4% Albumin Solution vs Ringer Acetate on Major Adverse Events in Patients Undergoing Cardiac Surgery With Cardiopulmonary Bypass: A Randomized Clinical Trial. JAMA. 2022; 328(3):251-258. PMC: 9297113. DOI: 10.1001/jama.2022.10461. View

20.

Ott D, Cooley D, Norman J, Sandiford F . DELAYED STERNAL CLOSURE: A USEFUL TECHNIQUE TO PREVENT TAMPONADE OR COMPRESSION OF THE HEART. Cardiovasc Dis. 1978; 5(1):15-18. PMC: 287699. View