Cardiogenic Shock
There are persons who, when they cease to shock us, cease to interest us - F H Bradley
image by: Resuscitation&Ultrasound
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Cardiogenic Shock Simplified
The overall goal in the management of the heart failure patient in cardiogenic shock is to stabilize them by maintaining oxygenation with NIPPV, maintaining sufficient cardiac perfusion with vasopressors, improving cardiac contractility with ionotropes and optimizing volume status so that they can be safely transported to the cath lab or operating room...
Resources
Cardiogenic Shock
As STEMI is the most common cause of cardiogenic shock, we will focus on the management of this disorder.
New Cardiogenic Shock Definitions Create Common Lexicon for Healthcare Teams
Experts at SCAI agree that pending validation, this long-awaited, five-category tool will enable patient differentiation and triage.
Contemporary Management of Cardiogenic Shock: A Scientific Statement...
Cardiogenic shock is a high-acuity, potentially complex, and hemodynamically diverse state of end-organ hypoperfusion that is frequently associated with multisystem organ failure. Despite improving survival in recent years, patient morbidity and mortality remain high, and there are few evidence-based therapeutic interventions known to clearly improve patient outcomes.
Management of cardiogenic shock complicating acute myocardial infarction
Cardiogenic shock complicates approximately 5–10% of cases with acute myocardial infarction and carries a poor prognosis. Early revascularization remains the cornerstone treatment of cardiogenic shock complicating myocardial infarction.
Study Examines Influence of Cardiac Arrest and Cardiogenic Shock on STEMI Patient Outcomes
Minneapolis Heart Institute Foundation study finds that presence of cardiac arrest and/or cardiogenic shock is responsible for more than 75 percent of hospital deaths in STEMI patients.
Mechanical Support Devices in Cardiogenic Shock
Despite an initial beneficial effect on MAP and arterial lactate, active percutaneous MCS did not improve mortality in comparison to control in patients with CS complicating AMI, which may be partly explained by an excess of complications such as bleeding.
Outcomes in patients undergoing percutaneous ventricular assist device implantation for cardiogenic shock
Percutaneous ventricular assist devices (PVADs) offer an important but resource-intensive option for management of severe cardiogenic shock (CS). Optimal selection of patients for PVAD support remains undefined. We investigated outcomes, including characteristics associated with in-hospital survival, during PVAD support for CS.
The Role of Short-Term Ventricular Assist Device in Patients with Cardiogenic Shock – Is It Really a Solution?
Currently short term uni- or biventricular Levotronix CentriMag VAD owing its capacity for full ventricular support represents an ideal solution for bridge to bridge or HTx.
A Simplified Approach to Cardiogenic Shock
Improve cardiac contractility with inotropes such as dobutamine or milrinone. Both of these agents are inotropes and vasodilators. A recent randomized control trial showed no significant difference in in-hospital survival and major cardiac outcomes with dobutamine versus milrinone in patients in cardiogenic shock.
Cardiogenic shock & severe LV failure
Cardiogenic shock isn't necessarily a discrete entity, but rather may be conceptualized as the most severe form of heart failure.
Diagnosing Cardiogenic Shock in the ED
When patients present to the ED hypotensive or hypoperfused, the RUSH exam is a quick way to differentiate shock by looking at the “the pump, the tank, and the pipes.
New Review Urges Rethink of Cardiogenic Shock Care
Its authors, pushing for more research, call for an “agnostic” approach to care that draws on multidisciplinary expertise.
Temporary circulatory support for cardiogenic shock
Cardiogenic shock can occur due to acute ischaemic or non-ischaemic cardiac events, or from progression of long-standing underlying heart disease. When addressing the cause of underlying disease, the management of cardiogenic shock consists of vasopressors and inotropes; however, these agents can increase myocardial oxygen consumption, impair tissue perfusion, and are frequently ineffective. An alternative approach is to temporarily augment cardiac output using mechanical devices. The use of these devices—known as temporary circulatory support systems—has increased substantially in recent years...
Improving Cardiogenic Shock Survival With New Protocols
Using best practices to change how the Abiomed Impella percutaneous ventricular assist device (pVAD) was used and which protocols to follow decreased mortality by 75 percent.
National Cardiogenic Shock Initiative Shows Potential to Increase Survival
Though randomized trials are needed to confirm the protocols, the study presenter says this algorithm could change outcomes.
Cardiogenic Shock Simplified
What are the best strategies to efficiently get the patient in cardiogenic shock to definitive care, whether that be the cath lab or the operating room?
Cardiogenic Shock and Circulatory Support Devices SDL
Summary of current devices.
Cardiogenic Shock therapy with Impella
Despite the pressing clinical need for improved outcomes in cardiogenic shock, the improvements in systems of care in STEMI with primary PCI (e.g., national door to balloon time initiatives) have not made an impact on systems of care for shock complicating AMI, in general.
Cardiogenic shock/VA ECMO/ECPR
What works/what doesn’t.
National Heart, Lung and Blood Institute
The most common cause of cardiogenic shock is a heart attack. Other health problems that may lead to cardiogenic shock include heart conditions such as heart failure; chest injuries; medicine side effects; and conditions that prevent blood from flowing freely through your heart, such as a blood clot in the lungs.
StatPearls
Cardiogenic shock is a clinical entity characterized by a low cardiac output state of circulatory failure that results in end-organ hypoperfusion and tissue hypoxia. The most common cause of cardiogenic shock is acute myocardial infarction, though other disorders leading to impairment of the myocardium, valves, conduction system, or pericardium also can result in cardiogenic shock.
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