Management of cardiogenic shock

Thiele, Holger; Ohman, E. Magnus; Desch, Steffen; Eitel, Ingo; Waha, Suzanne de

doi:10.1093/eurheartj/ehv051

Cited by 393 publications

(236 citation statements)

References 51 publications

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“…The use of IABP is recommended,31, 32 and although newer interventional devices have provided better hemodynamic support than the use of conventional IABP, none of these devices have yet been shown to favorably improve survival compared with the use of IABP 33, 34…”

Section: Discussionmentioning

confidence: 99%

Ten‐Year (2001–2011) Trends in the Incidence Rates and Short‐Term Outcomes of Early Versus Late Onset Cardiogenic Shock After Hospitalization for Acute Myocardial Infarction

Nguyen

Yarzebski

Lessard

et al. 2017

JAHA

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BackgroundCardiogenic shock (CS) is a serious complication of acute myocardial infarction, and the time of onset of CS has a potential role in influencing its prognosis. Limited contemporary data exist on this complication, however, especially from a population‐based perspective. Our study objectives were to describe decade‐long trends in the incidence, in‐hospital mortality, and factors associated with the development of CS in 3 temporal contexts: (1) before hospital arrival for acute myocardial infarction (prehospital CS); (2) within 24 hours of hospitalization (early CS); and (3) ≥24 hours after hospitalization (late CS).Methods and ResultsThe study population consisted of 5782 patients with an acute myocardial infarction who were admitted to all 11 hospitals in central Massachusetts on a biennial basis between 2001 and 2011. The overall proportion of patients who developed CS was 5.2%. The proportion of patients with prehospital CS (1.6%) and late CS (1.5%) remained stable over time, whereas the proportion of patients with early CS declined from 2.2% in 2001–2003 to 1.2% in 2009–2011. In‐hospital mortality for prehospital CS increased from 38.9% in 2001–2003 to 53.6% in 2009–2011, whereas in‐hospital mortality for early and late CS decreased over time (35.9% and 64.7% in 2001–2003 to 15.8% and 39.1% in 2009–2011, respectively).ConclusionsDevelopment of prehospital and in‐hospital CS was associated with poor short‐term survival and the in‐hospital death rates among those with prehospital CS increased over time. Interventions focused on preventing or treating prehospital and late CS are needed to improve in‐hospital survival after acute myocardial infarction.

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Section: Discussionmentioning

confidence: 99%

Ten‐Year (2001–2011) Trends in the Incidence Rates and Short‐Term Outcomes of Early Versus Late Onset Cardiogenic Shock After Hospitalization for Acute Myocardial Infarction

Nguyen

Yarzebski

Lessard

et al. 2017

JAHA

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“…23,24 Recently, other percutaneous MCS devices have shown promise in the treatment of CS, but more data from randomized clinical trials are needed. 25 …”

Section: Historical Perspectivesmentioning

confidence: 99%

“…2,3,[25][26][27] In general, there is a profound depression of myocardial contractility resulting in a potentially deleterious spiral of reduced cardiac output, low blood pressure, and further coronary ischemia, followed by additional reductions in contractility ( Figure 1). This cycle may lead to death.…”

Section: Pathophysiologymentioning

confidence: 99%

“…Currently, when, how, and which MCS device should be used remain unclear. 25 Randomized clinical trials in CS are difficult to perform, and few randomized clinical trials powered to detect differences in clinical outcome completed enrollment with the required number of patients. 1,9 The SHOCK trial was a milestone, and the subsequent widespread application of early revascularization led to a significant reduction in CS mortality.…”

Section: Future Directionsmentioning

confidence: 99%

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Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Diepen¹,

Katz²,

Albert³

et al. 2017

Circulation

1,206

1,165

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Cardiogenic shock is a high-acuity, potentially complex, and hemodynamically diverse state of end-organ hypoperfusion that is frequently associated with multisystem organ failure. Despite improving survival in recent years, patient morbidity and mortality remain high, and there are few evidence-based therapeutic interventions known to clearly improve patient outcomes. This scientific statement on cardiogenic shock summarizes the epidemiology, pathophysiology, causes, and outcomes of cardiogenic shock; reviews contemporary best medical, surgical, mechanical circulatory support, and palliative care practices; advocates for the development of regionalized systems of care; and outlines future research priorities. Cardiogenic shock (CS) is a low-cardiac-output state resulting in life-threatening end-organ hypoperfusion and hypoxia.1,2 Acute myocardial infarction (MI) with left ventricular (LV) dysfunction remains the most frequent cause of CS. 1,3 Advances in reperfusion therapy have been associated with improvements in survival, but significant regional disparities in evidence-based care have been reported, and in-hospital mortality remains high (27%-51%).1,4-9 Management recommendations are distributed between disease-specific statements and guidelines, and a dedicated and comprehensive clinical resource in this area is lacking. Thus, consolidating the evidence to define contemporary best medical and surgical CS practices for both MI-associated CS and other types of CS may be an important step in knowledge translation to help attenuate disparities in evidence-based care.Regional systems of care coupled with treatment algorithms have improved survival in high-acuity time-sensitive conditions such as MI, out-of-hospital cardiac arrest (OHCA), and trauma.10-12 Applying a similar framework to CS management may lead to similar improvements in survival, and CS systems of care are emerging within existing regional cardiovascular emergency care networks; however, guidance from a national expert group on structure and systems of care has not been available. 13,14 Accordingly, the purposes of this American Heart Association (AHA) scientific statement on CS are to summarize our contemporary understanding of the epidemiology, pathophysiology, and in-hospital best care practices into a single clinical resource document; to suggest a stepwise management algorithm that integrates medical, surgical, and mechanical circulatory support (MCS) therapies; and to propose a Mission: Lifelinesupported pathway for the development of integrated regionalized CS systems of care. DEFINITION OF CSAcute cardiac hemodynamic instability may result from disorders that impair function of the myocardium, valves, conduction system, or pericardium, either in isolation HISTORICAL PERSPECTIVESBefore the routine use of early revascularization, MIassociated CS had an in-hospital mortality exceeding 80%. A registry trial of 250 patients with acute MI described the association between bedside physical examination (Killip classification) for the as...

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“…IABP, which increases coronary perfusion and decreases myocardial oxygen consumption, has been the most widely used mechanical hemodynamic support device for nearly 50 years. Although recent European Society of Cardiology revascularization guidelines downgraded of the routine use of IABP in patients with cardiogenic shock with acute myocardial infarction as a new class IIIA recommendation, early IABP use at the onset of cardiogenic shock still shows a potential benefit in the prevention of multiorgan system dysfunction 7. Although not all patients with AF with a rapid ventricular response with low LVEF need mechanical hemodynamic support, we believe IABP is one of the choices to stabilize hemodynamics during PVI especially in patients with hemodynamically unstable AF.…”

Section: Discussionmentioning

confidence: 99%

Successful recovery of tachycardia‐induced cardiomyopathy with severely depressed left ventricular systolic function by catheter ablation with mechanical hemodynamic support: a case report

Kamada

Kubo

Sada

et al. 2016

Clinical Case Reports

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Key Clinical MessageWe describe the case that persistent atrial fibrillation refractory to rhythm control by pharmacotherapy and electrical cardioversions caused tachycardia‐induced cardiomyopathy with low ejection fraction and hemodynamic instability. Mechanical hemodynamic support using an intra‐aortic balloon pump is one of the choices of hemodynamic support during catheter ablation by pulmonary vein isolation.

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Management of cardiogenic shock

Cited by 393 publications

References 51 publications

Ten‐Year (2001–2011) Trends in the Incidence Rates and Short‐Term Outcomes of Early Versus Late Onset Cardiogenic Shock After Hospitalization for Acute Myocardial Infarction

Ten‐Year (2001–2011) Trends in the Incidence Rates and Short‐Term Outcomes of Early Versus Late Onset Cardiogenic Shock After Hospitalization for Acute Myocardial Infarction

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Successful recovery of tachycardia‐induced cardiomyopathy with severely depressed left ventricular systolic function by catheter ablation with mechanical hemodynamic support: a case report

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