Updates in the Management of Cardiogenic Shock in Acute Coronary Syndrome
- 836 Downloads
Cardiogenic shock is a complex clinical status characterized by a progressive multi-organ dysfunction determined by the failure of the heart to deliver an adequate amount of blood to the tissues. It complicates approximately 5–10% of cases with acute myocardial infarction. Ischemia due to decreased coronary perfusion leads to muscle hypoxia and necrosis which compromises myocardial contractility. This leads to decreased cardiac output and a subsequent drop in the arterial blood pressure. Coronary revascularization should be performed as soon as possible after AMI and shock onset. After the SHOCK trial, we have witnessed the reduction in the incidence of cardiogenic shock due to early revascularization. Although the primary endpoint, all-cause mortality at 30 days, did not differ between the initial medical stabilization and early revascularization group, there was a significant decrease in mortality after 1 and 6 years in patients assigned to early revascularization. In this chapter incidence, pathophysiology, etiology, clinical symptoms, and therapeutic options in cardiogenic shock are discussed. Two clinical cases and a case scenario allow the reader to get through the content.
KeywordsCardiogenic shock Acute coronary syndrome Advanced cardiovascular life support (ACLS) Extracorporeal membrane oxygenator (ECMO), Veno arterial Extracorporeal membrane oxygenator (VA-ECMO), Veno venous Extracorporeal membrane oxygenator (VV-ECMO) Left ventricular assist device (LVAD) Percutaneous coronary intervention (PCI) Intra-aortic balloon pump (IABP) Coronary bypass
- 5.Holmes DR Jr, Bates ER, Kleiman NS, et al. Contemporary reperfusion therapy for cardiogenic shock: the GUSTO-I trial experience. The GUSTO-I Investigators Global utilization of streptokinase and tissue plasminogen activator for occluded coronary arteries. J Am Coll Cardiol. 1995;26:668–74.CrossRefGoogle Scholar
- 6.Ponikowski P, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129–200. https://doi.org/10.1093/eurheartj/ehw128.CrossRefGoogle Scholar
- 11.Hussain F, Philipp RK, Ducas RA, et al. The ability to achieve complete revascularization is associated with improved in-hospital survival in cardiogenic shock due to myocardial infarction: manitoba cardiogenic shock registry investigators. Catheter Cardiovasc Interv. 2011;78:540–8.CrossRefGoogle Scholar
- 18.Sidebotham D. Troubleshooting adult ECMO. J Extra Corpor Technol. 2011;43:P27–32.Google Scholar