Mechanical support in cardiogenic shock

Herz
T Graf, Holger Thiele

Abstract

Treatment of patients in cardiogenic shock (CS) presenting with acute myocardial infarction (AMI) is still a challenge and mortality rates remain high, approaching 50 %. Hemodynamic stabilization before and/or after early revascularization remains the primary goal in these patients. In addition to hemodynamic support by inotropes and vasopressors, support with mechanical devices such as intra-aortic balloon pumping (IABP), percutaneous left ventricular assist devices (LVAD) and complete extracorporeal life support (ECLS) with extracorporeal membrane oxygenation (ECMO) may be considered. The use of IABP cannot be recommended anymore on a routine basis. Unfortunately, there are no large randomized data from studies evaluating treatment with mechanical support systems compared to standard treatment with respect to the clinical outcome of patients and no head-to-head comparison of different devices is available. Another important open question to be answered is which subgroups of patients may have a benefit from LVAD therapy. Guidelines discourage the routine use of mechanical support as a first-line treatment in CS patients and emphasize that the application should be restricted to those patients with refractory shock. This articl...Continue Reading

References

Dec 1, 1992·Journal of the American College of Cardiology·J R BengtsonR M Califf
Aug 3, 2004·Critical Care Medicine·H Bryant NguyenMichael C Tomlanovich
Feb 3, 2009·European Heart Journal·Holger Thiele, Gerhard Schuler
Apr 16, 2009·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·Christian JungMarkus Ferrari
Jul 9, 2010·European Heart Journal·Holger ThieleAntoine Lafont
Aug 27, 2010·Critical Care : the Official Journal of the Critical Care Forum·Luuk D H MunstermanCan Ince
Sep 11, 2010·Critical Care : the Official Journal of the Critical Care Forum·Christian JungMarkus Ferrari
Oct 1, 2010·The Journal of Thoracic and Cardiovascular Surgery·Yoan LamarcheRobert Moss
Mar 3, 2011·Interactive Cardiovascular and Thoracic Surgery·Sara Camilla ArrigoniMassimo Alessandro Mariani
Aug 28, 2012·The New England Journal of Medicine·Holger ThieleUNKNOWN IABP-SHOCK II Trial Investigators
Sep 10, 2013·Lancet·Holger ThieleUNKNOWN Intraaortic Balloon Pump in cardiogenic shock II (IABP-SHOCK II) trial investigators
Oct 4, 2014·Journal of the American College of Cardiology·Robert StretchPramod Bonde

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