Experts’ recommendations for the management of cardiogenic shock in children

Abstract

Cardiogenic shock which corresponds to an acute state of circulatory failure due to impairment of myocardial contractility is a very rare disease in children, even more than in adults. To date, no international recommendations regarding its management in critically ill children are available. An experts’ recommendations in adult population have recently been made (Levy et al. Ann Intensive Care 5(1):52, 2015; Levy et al. Ann Intensive Care 5(1):26, 2015). We present herein recommendations for the management of cardiogenic shock in children, developed with the grading of recommendations’ assessment, development, and evaluation system by an expert group of the Groupe Francophone de Réanimation et Urgences Pédiatriques (French Group for Pediatric Intensive Care and Emergencies). The recommendations cover four major fields of application such as: recognition of early signs of shock and the patient pathway, management principles and therapeutic goals, monitoring hemodynamic and biological variables, and circulatory support (indications, techniques, organization, and transfer criteria). Major principle care for children with cardiogenic shock is primarily based on clinical and echocardiographic assessment. There are few drugs reported as effective in childhood in the medical literature. The use of circulatory support should be facilitated in terms of organization and reflected in the centers that support these children. Children with cardiogenic shock are vulnerable and should be followed regularly by intensivist cardiologists and pediatricians. The experts emphasize the multidisciplinary nature of management of children with cardiogenic shock and the importance of effective communication between emergency medical assistance teams (SAMU), mobile pediatric emergency units (SMUR), pediatric emergency departments, pediatric cardiology and cardiac surgery departments, and pediatric intensive care units.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-016-0111-2) contains supplementary material, which is available to authorized users.

Outcomes of venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock: systematic review and meta-analysis

“…Despite advances in management techniques and medical therapy, refractory cardiogenic shock remains a lifethreatening condition with high mortality rates (1). Both low cardiac output and poor tissue perfusion characterize cardiogenic shock and hence a great deal of emphasis is placed on the use of inotropic and vasopressor agents, mechanical assistance and fluid maintenance to support cardiac function (2). Mechanical support for the management of cardiogenic shock was first assessed in animal trials as early as the 1930s, with extension to human trials in the late 1960s in the setting of infants with respiratory sepsis (3)(4)(5).…”

Lebensrettende Maßnahmen bei Kindern (Paediatric Life Support, PLS)

“…Nach der Bestätigung der Diagnose besteht das allgemeine Vorgehen darin, eine Volumenüberladung zu vermeiden. Allerdings können Patienten mit nachgewiesener verminderter Vorlast, die aufgrund klinischer oder biochemischer Gründe oder echokardiographisch angenommen wird, beispielsweise im Rahmen einer geringen Flüssigkeitsaufnahme oder einer damit verbundenen Sepsis von einer vorsichtigen Flüssigkeitstherapie profitieren [ 39 ].…”

Akute Herzinsuffizienz und kardiogener Schock in der Kindernotaufnahme

“…▶ Tab. 1 Klinische Zeichen akuter Herzinsuffizienz bei Kindern (modifiziert nach [5] Bei Erwachsenen sind Messungen von BNP bzw. NTpro-BNP als Biomarker fest etabliert und verfügen neben dem differenzialdiagnostischen Nutzen über einen prognostischen Wert [10].…”

“…Auch im Kindesalter kann die Bestimmung von BNP bzw. NT-pro-BNP zur Diagnosestellung beitragen und wird daher empfohlen [5]. Sie sollte möglich frühzeitig erfolgen und Bestandteil der Laborwertbestimmung sein, wenn die Differenzialdiagnosen akute Herzinsuffizienz oder kardiogener Schock im Raum erwogen werden.…”