Cardiogenic Shock

Abstract

Cardiogenic shock (CS) is an end-organ hypoperfusion associated with heart failure. Any reason impairing acute left ventricular (LV) or right ventricular (RV) function may cause CS. The only way to avoid CS is to provide early reperfusion in myocardial infarction (MI) patients. CS is characterized by permanent or transient rearrangement of the entire circulatory system. According to the current IABP-SHOCK II trial, 74% of the patients with CSMI are treated with norepinephrine, 53% of them with dobutamine, 26% of them with epinephrine, 4% of them with levosimendan, and 4% of them with dopamine. Percutaneous circulatory support devices such as intra-aortic balloon pump (IABP), LV assist device (LVAD), or extracorporeal life support (ECLS) create treatment options for selected patients such as CS, cardiopulmonary resuscitation, or high-risk pPCI and CABG. Extracorporeal Life Support Organization (ELSO, 2017) evaluated that the use of ECLS/VA-ECMO should be considered when the mortality risk exceeds 50% despite optimal conventional treatment in case of acute severe heart or pulmonary failure, whereas it should be assessed as a primary indication when it exceeds 80%. Early and effective revascularization is the best treatment option for CS. Thus, the organizations on the national and global basis will play the most effective role for the short-and long-term survival of patients.to survive [2]. CS occurs in approximately 5-8% of inpatients with ST-elevation myocardial infarctions (STEMI) and has a mortality rate of more than 30% [1]. CS is caused by end-organ hypoperfusion due to impaired cardiac pump function. Although CS-related mortality has declined significantly over the past decade, it continues to remain high, especially in cases of its coexistence with ischemic heart disease. Acute coronary syndrome (ACS) is still the most common cause of CS despite significant advances that have been made in its diagnosis and treatment. The most successful form of treatment is primary percutaneous coronary intervention (pPCI), which is carried out as rapidly as possible [3]. The recent research has suggested that the peripheral vasculature and neurohormonal and cytokine systems also play a role in the pathogenesis and persistence of CS.In cases where CS complicates MI (CSMI), only one in two patients survives after 1 year [4,5]. In a large study including 5782 patients, CSMI had developed in 2.5% of the patients with STEMI before admission to hospital, in 4.3% of them on the first day of hospitalization, and in 2.3% of them afterward [6]. For non-STEMI (NSTEMI) patients, these ratios were 1.2% for each condition [6]. Mortality rates were 45.7% before the hospitalization, 32.8% in the early period, and 54.1% in the late period [7]. Of 1422 CSMI patients, in the SHOCK Trial Registry, a shock is developed following left ventricular failure in 78.5% of them, acute mitral insufficiency in 6.9% of them, acute ventricular septal defect in 3.9% of them, right ventricular failure in 2.8% of them, cardiac tamponade in 1.4% of them, and ...