Management of cardiogenic shock.
Cardiogenic shock (CS) remains the most common cause of death in patients with acute myocardial infarction although mortality could be reduced from formerly ∼80% to 40-50%. In addition to percutaneous coronary intervention or coronary artery bypass grafting, catecholamines, fluids, intraaortic balloon pumping (IABP), and also active assist devices are widely used for CS management. However, there is only limited evidence for any of the above treatments except for early revascularization and the relative ineffectiveness of IABP. This updated review will therefore outline the management of CS complicating acute myocardial infarction with major focus on evidence-based revascularization techniques, intensive care unit treatment including ventilation, transfusion regimens, adjunctive medication, and mechanical support devices.
Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Centre Luebeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Luebeck 23538, Germany holger.thiele@uksh.de.
Holger
H
Thiele
Duke University Medical Centre, Durham, NC, USA.
E Magnus
EM
Ohman
Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Centre Luebeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Luebeck 23538, Germany.
Steffen
S
Desch
Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Centre Luebeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Luebeck 23538, Germany.
Ingo
I
Eitel
Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Centre Luebeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, Luebeck 23538, Germany.
Suzanne
S
de Waha
D003422:Critical Care / Q000379:methods; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005544:Forecasting; D006353:Heart-Assist Devices; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods; D007423:Intra-Aortic Balloon Pumping / Q000379:methods; D009204:Myocardial Revascularization / Q000379:methods; D062645:Percutaneous Coronary Intervention / Q000379:methods; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011379:Prognosis; D011474:Prosthesis Design; D012770:Shock, Cardiogenic / Q000628:therapy*
D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors
Assist device; Heart failure; Myocardial infarction; Percutaneous coronary intervention; Shock; Treatment