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The Management of Cardiogenic Shock From Diagnosis to Devices: A Narrative Review. | LitMetric

The Management of Cardiogenic Shock From Diagnosis to Devices: A Narrative Review.

CHEST Crit Care

Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.

Published: June 2024

AI Article Synopsis

  • Cardiogenic shock (CS) is a serious condition characterized by insufficient cardiac output, resulting in tissue damage and organ dysfunction, with a high mortality rate.
  • The management of CS has evolved significantly, particularly with the use of temporary mechanical circulatory support (tMCS) devices, necessitating an understanding of patient assessment and treatment strategies in ICUs.
  • The article reviews causes, pathophysiology, diagnosis, and staging of CS, emphasizing the importance of tailored medical and mechanical therapies based on the type and severity of heart failure in affected patients.

Article Abstract

Cardiogenic shock (CS) is a heterogenous syndrome broadly characterized by inadequate cardiac output leading to tissue hypoperfusion and multisystem organ dysfunction that carries an ongoing high mortality burden. The management of CS has advanced rapidly, especially with the incorporation of temporary mechanical circulatory support (tMCS) devices. A thorough understanding of how to approach a patient with CS and to select appropriate monitoring and treatment paradigms is essential in modern ICUs. Timely characterization of CS severity and hemodynamics is necessary to optimize outcomes, and this may be performed best by multidisciplinary shock-focused teams. In this article, we provide a review of CS aimed to inform both the cardiology-trained and non-cardiology-trained intensivist provider. We briefly describe the causes, pathophysiologic features, diagnosis, and severity staging of CS, focusing on gathering key information that is necessary for making management decisions. We go on to provide a more detailed review of CS management principles and practical applications, with a focus on tMCS. Medical management focuses on appropriate medication therapy to optimize perfusion-by enhancing contractility and minimizing afterload-and to facilitate decongestion. For more severe CS, or for patients with decompensating hemodynamic status despite medical therapy, initiation of the appropriate tMCS increasingly is common. We discuss the most common devices currently used for patients with CS-phenotyping patients as having left ventricular failure, right ventricular failure, or biventricular failure-and highlight key available data and particular points of consideration that inform tMCS device selection. Finally, we highlight core components of sedation and respiratory failure management for patients with CS.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11238736PMC
http://dx.doi.org/10.1016/j.chstcc.2024.100071DOI Listing

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