Top Things to Know: Contemporary Management of Cardiogenic Shock
Published: September 18, 2017
- This scientific statement serves as a comprehensive clinical resource on cardiogenic shock including epidemiology, pathophysiology, best practices, management algorithms, and the value of regionalized systems-of-care.
- Cardiogenic shock is defined as ineffective cardiac output due to a primary cardiac insult that results in inadequate tissue perfusion. Additional definitions in clinical practice guidelines as well as operationalized definitions from clinical trials are further described.
- Hemodynamic phenotypes and etiologies of cardiogenic shock are described.
- Testing in cardiogenic shock is discussed including laboratory evaluation, non-invasive imaging, and hemodynamic monitoring.
- Regionalizing care for patients with cardiogenic shock and the possibility of improved patient outcomes with high-volume centers serving as referral hubs is discussed.
- Reperfusion and revascularization are the primary evidence-based therapies for patients with cardiogenic shock secondary to an acute myocardial infraction.
- Hemodynamic monitoring should complement other markers of end organ perfusion, but set target goals in cardiogenic shock have not been well established.
- Medical therapy of cardiogenic shock including vasopressors and inotropes is outlined.
- The role of temporary and durable mechanical circulatory support devices, as well as investigational therapies that may be available in the future, are described.
- The importance of palliative care in the multidisciplinary care of patients with cardiogenic shock is reinforced.
Citation
van Diepen S, Katz JN, Albert NM, Henry TD, Jacobs AK, Kapur NK, Kilic A, Menon V, Ohman EM, Sweitzer NK, Thiele H, Washam JB, Cohen MG; on behalf of the American Heart Association Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Quality of Care and Outcomes Research; and Mission: Lifeline. Contemporary management of cardiogenic shock: a scientific statement from the American Heart Association [published online ahead of print September 18, 2017]. Circulation. doi: 10.1161/CIR.0000000000000525.