Advertisement

Cardiogenic Shock and Mechanical Circulatory Support

  • Stephen P. Hoole
  • Alain Vuylsteke
Chapter

Abstract

Cardiogenic shock (CS) is sustained hypotension with inadequate tissue perfusion in spite of adequate left ventricular filling pressure. This is manifested by tissue hypoperfusion and organ dysfunction. The natural history of cardiogenic shock is a downward spiral of ischemic left ventricular (LV) systolic dysfunction and worsening end-organ perfusion, leading to death. The commonest cause of CS is acute myocardial infarction (MI), complicating approximately 2–3% of acute MI (BCIS database 2014). The prognosis is poor, despite instigating supportive treatment, and the mortality rate is greater than 50%. This chapter will review the treatment of CS including the role of mechanical circulatory support after acute MI and/or for patients requiring high-risk percutaneous coronary intervention.

Keywords

Cardiogenic shock Intra-aortic balloon pump (IABP) Ventricular assist device (VAD) Extracorporeal cardiac life support (ECLS) Extracorporeal membrane oxygenation (ECMO) Cardiac transplantation 

References

  1. 1.
  2. 2.
    Sanborn TA, Sleeper LA, Bates ER, et al. Impact of thrombolysis, intra-aortic balloon pump counterpulsation, and their combination in cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK? J Am Coll Cardiol. 2000;36(3 Suppl A):1123–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Hochman JS, Sleeper LA, Webb JG, et al. 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.CrossRefPubMedGoogle Scholar
  4. 4.
    Windecker S, Kohl P, Alfonso F, et al. 2014 ESC/EACTS guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2014;35(37):2541–619.CrossRefPubMedGoogle Scholar
  5. 5.
    Kern MJ. Intra-aortic balloon counterpulsation. Coron Artery Dis. 1991;2(6):649–60.Google Scholar
  6. 6.
    Sjauw KD, Engstrom AE, Vis MM, et al. A systematic review and meta-analysis of intra-aortic balloon pump therapy in ST-elevation myocardial infarction: should we change the guidelines? Eur Heart J. 2009;30(4):459–68.CrossRefPubMedGoogle Scholar
  7. 7.
    Thiele H, Zeymer U, Neumann FJ, et al. Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med. 2012;367(14):1287–96.CrossRefPubMedGoogle Scholar
  8. 8.
    Patel MR, Smalling RW, Thiele H, et al. Intra-aortic balloon counterpulsation and infarct size in patients with acute anterior myocardial infarction without shock: the CRISP AMI randomized trial. JAMA. 2011;306(12):1329–37.CrossRefPubMedGoogle Scholar
  9. 9.
    Cheng JM, den Uil SE, van der Ent M, et al. Percutaneous left ventricular assist devices vs. intra-aortic balloon pump counterpulsation for treatment of cardiogenic shock: a meta-analysis of controlled trials. Eur Heart J. 2009;30:2102–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Seyfarth M, Sibbing D, Bauer I, et al. A randomized clinical trial to evaluate the safety and efficacy of a percutaneous left ventricular assist device versus intra-aortic balloon pumping for treatment of cardiogenic shock caused by myocardial infarction. J Am Coll Cardiol. 2008;52(19):1584–8.CrossRefPubMedGoogle Scholar
  11. 11.
    O'Neill WW, Kleiman NS, Moses J, et al. A prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: the PROTECT II study. Circulation. 2012;126(14):1717–27.CrossRefPubMedGoogle Scholar
  12. 12.
    Thiele H, Sick P, Boudriot E, Diederich KW, et al. Randomized comparison of intra-aortic balloon support with a percutaneous left ventricular assist device in patients with revascularized acute myocardial infarction complicated by cardiogenic shock. Eur Heart J. 2005;26:1276–83.CrossRefPubMedGoogle Scholar
  13. 13.
    Extracorporeal Life Support Organization. General Guidelines for all ECLS cases Version 1:1. April 2009. http://www.elso.med.umich.edu/WordForms/ELSO%20Guidelines%20General%20All%20ECLS%20Versio n1.1.pdf
  14. 14.
    Sheu JJ, Tsai TH, Lee FY, et al. Early extracorporeal membrane oxygenator-assisted primary percutaneous coronary intervention improved 30-day clinical outcomes in patients with ST-segment elevation myocardial infarction complicated with profound cardiogenic shock. Crit Care Med. 2010;38(9):1810–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Miller LW, Pagani FD, Russell SD, et al. Use of a continuous-flow device in patients awaiting heart transplantation. N Engl J Med. 2007;357(9):885–96.CrossRefPubMedGoogle Scholar
  16. 16.
    Mehra MR, Canter CE, Hannan MM, et al. The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: a 10-year update. J Heart Lung Transplant. 2016;35(1):1–23.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Royal Papworth HospitalCambridgeUK

Personalised recommendations