title: Management of refractory cardiogenic shock.
abstract: Cardiogenic shock is a life-threatening condition that occurs in response to reduced cardiac output in the presence of adequate intravascular volume and results in tissue hypoxia. Cardiogenic shock has several underlying aetiologies, with the most common being acute myocardial infarction (AMI). Refractory cardiogenic shock presents as persistent tissue hypoperfusion despite administration of adequate doses of two vasoactive medications and treatment of the underlying aetiology. Investigators of the SHOCK trial reported a long-term mortality benefit of emergency revascularization for shock complicating AMI. Since the publication of the SHOCK trial and subsequent guideline recommendations, the increase in community-based use of percutaneous coronary intervention for this condition has resulted in a significant decline in mortality. Despite these successes in the past 15 years, mortality still remains exceptionally high, particularly in patients with refractory cardiogenic shock. In this Review, we discuss the aetiology and pathophysiology of cardiogenic shock and summarize the data on the available therapeutics and their limitations. Although new mechanical circulatory support devices have been shown to improve haemodynamic variables in patients with shock complicating AMI, they did not improve clinical outcomes and are associated with high costs and complications.
authors.affiliation: Division of Cardiology, New York University-Langone Medical Center, 530 First Avenue, New York, New York 10016, USA.
authors.forename: Alex
authors.initials: A
authors.lastname: Reyentovich
authors.affiliation: Division of Cardiology, New York University-Langone Medical Center, 530 First Avenue, New York, New York 10016, USA.
authors.forename: Maya H
authors.initials: MH
authors.lastname: Barghash
authors.affiliation: Department of Medicine, Cardiovascular Clinical Research Center, 530 First Avenue, New York, New York 10016, USA.
authors.forename: Judith S
authors.initials: JS
authors.lastname: Hochman
mesh_terms: D002317:Cardiovascular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D006353:Heart-Assist Devices; D006439:Hemodynamics / Q000187:drug effects*; D017052:Hospital Mortality; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D009204:Myocardial Revascularization / Q000009:adverse effects / Q000401:mortality; D011474:Prosthesis Design; D020127:Recovery of Function; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D016276:Ventricular Function / Q000187:drug effects*
chemical_list: D002317:Cardiovascular Agents