The Hemodynamically Labile Patient: Cardiovascular Adjuncts and Assist Devices

  • Edward E. CornwellIII
  • Preeti R. John


A 66-year-old retired teacher is being managed in the intensive care unit after having a myocardial infarction. The patient had no prior medical problems. The patient is hemodynamically labile and is refractory to volume support and all pharmacologic interventions. The patient is now in profound cardiogenic shock. Which of the following would most likely be the management of choice?
  1. (A)

    Emergency cardiac catheterization

  2. (B)

    Coronary artery bypass surgery

  3. (C)

    Intraaortic balloon pump

  4. (D)

    Continue inotropic support

  5. (E)

    No further intervention is needed



Cardiogenic Shock Extracorporeal Membrane Oxygenation Arginine Vasopressin ECMO Support Intraaortic Balloon 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Chernow B, Rothl BL. Pharmacological manipulation of the peripheral vasculature in shock: clinical and experimental approaches. Circ Shock 1986; 18:141–155.PubMedGoogle Scholar
  2. 2.
    Landry DW, Levin HR, Gallant EM, et al. Vasopressin pressor hypersensitivity in vasodilatory septic shock. Crit Care Med 1997; 25(8):1279–1282.CrossRefPubMedGoogle Scholar
  3. 3.
    Landry DW, Levin HR, Gallant EM, et al. Vasopressin deficiency contributes to the vasodilation of septic shock. Circulation 1997; 95:1122–1125.PubMedGoogle Scholar
  4. 4.
    Reid IA. Role of vasopressin deficiency in the vasodilation of septic shock. Circulation, 1997; 95:1108–1110.PubMedGoogle Scholar
  5. 5.
    Dunser MW, Mayr AJ, Ulmer H, et al. Arginine vasopressin in advanced shock: a prospective, randomized, controlled study. Circulation 2003; 107(18):2313–1319.CrossRefPubMedGoogle Scholar
  6. 6.
    Patel BM, Chittock DR, Russell JA, et al. Beneficial effects of short-term vasopressin infusion during severe septic shock. Anesthesiology 2002; 96(3):576–582.CrossRefPubMedGoogle Scholar
  7. 7.
    Malay MB, Ashton RC Jr, Landry DW, et al. Low-dose vasopressin in the treatment of vasodilatory septic shock. J Trauma 1999; 47(4):699–703.CrossRefPubMedGoogle Scholar
  8. 8.
    Argenziano M, Choudhri AF, Oz MC, et al. A prospective randomized trial of arginine vasopressin in the treatment of vasodilatory shock after left ventricular assist device placement. Circulation 1997; 96(Suppl II):II-286–II-290.Google Scholar
  9. 9.
    Hill D, O’Brien TG, Murray JJ, et al. Extracorporeal oxygenation for acute post-traumatic respiratory failure (shock lung syndrome). Use of the Bramson membrane lung. N Engl J Med 1972; 286:629–634.PubMedCrossRefGoogle Scholar
  10. 10.
    Doll N, Kiaii B, Borger M, et al. Five year results of 219 consecutive patients treated with extracorporeal membrane oxygenation for refractory postoperative cardiogenic shock. Ann Thorac Surg 2004; 77:151–157.CrossRefPubMedGoogle Scholar
  11. 11.
    Schwarz B, Mair P, Margreikter J, et al. Experience with percutaneous venoarterial cardiopulmonary bypass for emergency circulatory support. Crit Care Med 2003; 31(3): 758–764.CrossRefPubMedGoogle Scholar
  12. 12.
    Ko WJ, Lin CY, Chen RJ, et al. Extracorporeal membrane oxygenation support for adult postcardiotomy cardiogenic shock. Ann Thorac Surg 2002; 73(2):538–545.CrossRefPubMedGoogle Scholar
  13. 13.
    Kantrowitz A, Tjonneland S, Freed PS, et al. Initial clinical experience with intraaortic balloon pumping in cardiogenic shock. JAMA 1968; 203:113–118.CrossRefPubMedGoogle Scholar
  14. 14.
    Baskett RJF, O’Connor GT, Hirsch GM, et al. A multicenter comparison of intraaortic balloon pump utilization in isolated coronary artery bypass graft surgery. Ann Thorac Surg 2003; 76:1988–1992.CrossRefPubMedGoogle Scholar
  15. 15.
    Stone GW, Magnus Ohman E, Miller MF, et al. Contemporary utilization and outcomes of intra-aortic balloon counterpulsation in acute myocardial infarction. J Am Coll Cardiol 2003; 41:1940–1950.CrossRefPubMedGoogle Scholar
  16. 16.
    Christenson JT, Simonet F, Badel P, et al. Optimal timing of preoperative intra-aortic balloon pump support in highrisk coronary patients. Ann Thorac Surg 1999; 68:934–939.CrossRefPubMedGoogle Scholar
  17. 17.
    Christenson JT, Badel P, Simonet F, et al. Preoperative intraaortic balloon pump enhances cardiac performance and improves the outcome of redo CABG. Ann Thorac Surg 1997; 64:1237–1244.CrossRefPubMedGoogle Scholar
  18. 18.
    Christenson JT, Simonet F, Badel P, et al. Evaluation of preoperative intra-aortic balloon pump support in high risk coronary patients. Eur J Cardiothorac Surg 1997; 11(6): 1097–1103CrossRefPubMedGoogle Scholar
  19. 19.
    Ohman EM, George BS, White CJ, et al. Use of aortic counterpulsation to improve sustained coronary artery patency during acute myocardial infarction. Results of a randomized trial. The randomized IABP study group. Circulation 1994; 90(2):792–799.PubMedGoogle Scholar
  20. 20.
    Madigan JD, et al. Time course of reverse modeling of the left ventricle during support with a left ventricular assist device. J Thorac Cardiovasc Surg 2001; 121(5):902–908.CrossRefPubMedGoogle Scholar
  21. 21.
    Mehta SM, et al. Mechanical ventricular assistance: an economical and effective means of treating end-stage heart disease. Ann Thorac Surg 1995; 60(2):284–290.CrossRefPubMedGoogle Scholar
  22. 22.
    Aaronson KD, et al. Left ventricular assist device therapy improves utilization of donor hearts. J Am Coll Cardiol 2002; 39(8):1247–1254.CrossRefPubMedGoogle Scholar
  23. 23.
    Frazier OH, Reynolds M, Delgado M. Mechanical circulatory support for advanced heart failure. Where does it stand in 2003? Circulation 2003; 108:3064–3068.CrossRefPubMedGoogle Scholar
  24. 24.
    Goldstein DJ, Oz MC, Rose EA. Implantable left ventricular assist devices. N Engl J Med 1998; 339(21):1522–1533.CrossRefPubMedGoogle Scholar
  25. 25.
    Rose EA, Gelijns AC, Moskowitz AJ, et al. Long-term mechanical ventricular assistance for end-stage heart failure. N Engl J Med 2001; 15(20):1435–1443.CrossRefGoogle Scholar
  26. 26.
    Rose EA, Moskowitz AJ, Packer M, et al. The REMATCH trial: rationale, design, and end points. Ann Thorac Surg 1999; 67:723–730.CrossRefPubMedGoogle Scholar
  27. 27.
    Richenbacher WE, Naka Y, Raines NY, et al. Surgical management of patients in the REMATCH trial. Ann Thorac Surg 2003; 75(Suppl):S86–S92.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Edward E. CornwellIII
    • 1
  • Preeti R. John
    • 2
  1. 1.Department of Surgery, Johns Hopkins School of MedicineJohns Hopkins HospitalBaltimoreUSA
  2. 2.Department of Surgery, Johns Hopkins UniversityThe Johns Hopkins HospitalBaltimoreUSA

Personalised recommendations