Materiały źródłowe

• #1 Cardiogenic shock – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cardiogenic-shock/diagnosis-treatment/drc-20366764

  Cardiogenic shock treatment focuses on reducing the damage from lack of oxygen to your heart muscle and other organs. […] Most people who have cardiogenic shock need extra oxygen. If necessary, you’ll be connected to a breathing machine (ventilator). You’ll receive medications and fluid through an IV line in your arm. […] Fluids and plasma are given through an IV. Medications to treat cardiogenic shock are given to increase your heart’s pumping ability and reduce the risk of blood clots. […] These medications are used to treat low blood pressure. They include dopamine, epinephrine (Adrenaline, Auvi-Q), norepinephrine (Levophed) and others. […] These medications, which help improve the pumping function of the heart, may be given until other treatments start to work. They include dobutamine, dopamine and milrinone.

• #2 Cardiogenic Shock: Risk Factors, Causes and Symptoms

  https://my.clevelandclinic.org/health/diseases/17837-cardiogenic-shock

  Cardiogenic shock is a serious condition that happens when your heart cant supply enough oxygen-rich blood to your body to meet its needs. It can be fatal when a lack of oxygen causes your organs to fail. […] This condition is an emergency situation that requires immediate treatment in a hospital. […] Cardiogenic shock is a life-threatening condition and you need emergency treatment. The most important part of treatment is improving the flow of blood and oxygen to major organs to avoid damage. Sometimes, this can be achieved with medications. In more severe cases, support devices may be needed to help your heart. […] Treatment that begins in a hospital emergency room or intensive care unit may include: Medications given through an IV to help remove excess fluid, improve blood flow, and support your heart function.

• #3 Cardiogenic Shock – Treatment | NHLBI, NIH

  https://www.nhlbi.nih.gov/health/cardiogenic-shock/treatment

  Cardiogenic shock is life-threatening, but it is treatable if diagnosed and treated quickly. […] At the hospital, you may need medicines and a procedure to restore blood flow to your heart. You may also need other emergency treatment, including temporary medical devices, to stabilize or support you until you receive a permanent device or have a heart transplant. […] Medicine can help increase blood flow and protect against organ damage. Some medicines treat the underlying cause of cardiogenic shock, which is usually a heart attack. […] Some medical procedures may be done right away to restore blood flow within your heart and throughout your body, preventing organ damage. […] Coronary artery bypass grafting (CABG) is a procedure to improve poor blood flow to the heart muscle. […] Percutaneous coronary intervention (PCI), also called coronary angioplasty, is a nonsurgical procedure that improves blood flow to your heart.

• #4 Cardiogenic Shock Treatment Options | Temple Health

  https://www.templehealth.org/services/conditions/cardiogenic-shock/treatment-options

  The goal of cardiogenic shock treatment is to quickly restore blood pressure and heart function. This often requires a series of emergency treatments that are given in an ambulance or the Emergency Department. Other treatments may include medications or temporary support devices to restore blood flow. […] These treatments may include enriched oxygen in a tube or mask; breathing assistance (ventilator); intravenous (IV) fluids and medications to boost blood pressure or heart function. […] There is an array of medications that may be given to treat cardiogenic shock. These vary depending upon the cause of the shock and may include: Thrombolytic drugs to dissolve coronary artery clots („clot-busting” drugs such as tPA), Anticlotting agents to prevent new clots (e.g., aspirin, clopidogrel, heparin), Drugs to increase the heart’s pumping ability (e.g., dobutamine, dopamine, epinephrine), Other possible therapies include: oxygen to protect heart tissue; nitroglycerin to widen coronary vessels; drugs to decrease the heart’s workload and pain, relieve anxiety or regulate heart rhythm.

• #5 Cardiogenic shock Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/cardiogenic-shock

  Cardiogenic shock is a medical emergency. You will need to stay in the hospital, most often in the Intensive or Coronary Care Unit (ICU). The goal of treatment is to find and treat the cause of shock to save your life. […] You may need medicines to increase blood pressure and improve heart function, including: Dobutamine, Dopamine, Epinephrine, Levosimendan, Milrinone, Norepinephrine, Vasopressin. […] When a heart rhythm disturbance (dysrhythmia) is serious, urgent treatment may be needed to restore a normal heart rhythm. This may include: Electrical „shock” therapy (defibrillation or cardioversion), Implanting a temporary pacemaker, Medicines given through a vein (IV). […] Other treatments for shock may include: Cardiac catheterization with coronary angioplasty and stenting, Heart monitoring to guide treatment, Heart surgery (coronary artery bypass surgery, heart valve replacement, left ventricular assist device), Intra-aortic balloon counterpulsation (IABP) to help the heart work better, Pacemaker, Ventricular assist device or other mechanical support.

• #6 Cardiogenic Shock – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482255/

  Cardiogenic shock is an emergency requiring immediate resuscitative therapy before the irreversible damage of vital organs. Rapid diagnosis with prompt initiation of pharmacological therapy to maintain blood pressure and to maintain respiratory support along with a reversal of underlying cause plays a vital role in the prognosis of patients with cardiogenic shock. […] Early restoration of coronary blood is the most important intervention and is the standard therapy for patients with cardiogenic shock due to myocardial infarction. […] The management of cardiogenic shock involves the following: […] The goal of medical management is to restore cardiac output and prevent irreversible end-organ damage rapidly. […] Norepinephrine is preferred over dopamine in patients with severe hypotension (systolic blood pressure less than 70 mm Hg) or hypotension unresponsive to other medications as dopamine has been associated with higher rates of arrhythmias and a higher risk of mortality in this patient population.

• #7 Cardiogenic Shock Treatment & Management: Approach Considerations, Prehospital Care, Resuscitation, Ventilation, and Pharmacologic Intervention

  https://emedicine.medscape.com/article/152191-treatment

  Consider continuous renal replacement therapy in patients with stage 2 acute kidney injury. […] Prehospital care is aimed at minimizing any further ischemia and shock. […] Initial management includes fluid resuscitation to correct hypovolemia and hypotension, unless pulmonary edema is present. […] Norepinephrine, epinephrine, and dopamine are vasoconstricting drugs that help to maintain adequate blood pressure during life-threatening hypotension and help to preserve perfusion pressure for optimizing flow in various organs. […] The use of the IABP reduces systolic LV afterload and augments diastolic coronary perfusion pressure, thereby increasing cardiac output and improving coronary artery blood flow. […] Various LV assist devices (LVADs) capable of providing complete short-term hemodynamic support have been developed.

• #8 Cardiogenic Shock – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482255/

  Dobutamine is widely used, has beta-1 and beta-2 agonist properties, which can improve myocardial contractility, lower left ventricular end-diastolic pressure, and increased cardiac output. […] Fibrinolytic therapy should be administered to patients who are unsuitable candidates for either percutaneous coronary intervention or coronary artery bypass graft if there are no contraindications. […] Primary percutaneous coronary intervention (PCI) should be performed, irrespective of time delay from the onset of myocardial infarction. […] Urgent coronary artery bypass grafting is indicated in patients with coronary anatomy not amenable to PCI. […] Due to the poor prognosis associated with cardiogenic shock, medical therapy is often inadequate, and mechanical circulatory support (MCS) therapy to improve end-organ perfusion may be required.

• #9 Cardiogenic Shock Medication: Inotropic Agents, Vasodilators, Antiplatelet Agents, Cardiovascular, Opioid Analgesics, Diuretics, Loop, Cardiovascular, Other

  https://emedicine.medscape.com/article/152191-medication

  Norepinephrine is generally reserved for use in patients with severe hypotension (eg, systolic blood pressure 70 mm Hg) or hypotension unresponsive to other medication. […] Dobutamine is a sympathomimetic amine with stronger beta effects than alpha effects. It produces systemic vasodilation and increases the inotropic state. Higher doses may cause an increase in heart rate, exacerbating myocardial ischemia. […] Milrinone is a selective phosphodiesterase inhibitor in cardiac and vascular tissue with positive inotropic and vasodilator effects; it has little chronotropic activity. […] Inamrinone is a phosphodiesterase inhibitor with positive inotropic and vasodilator activity. It produces vasodilation and increases the inotropic state. Inamrinone is more likely to cause tachycardia than is dobutamine, and it may exacerbate myocardial ischemia.

• #10 Cardiogenic shock – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cardiogenic-shock/diagnosis-treatment/drc-20366764

  Aspirin is usually given immediately to reduce blood clotting and keep blood moving through a narrowed artery. […] Emergency room doctors might give you drugs similar to aspirin to help prevent new clots from forming. These medications include clopidogrel (Plavix), tirofiban (Aggrastat) and eptifibatide (Integrilin). […] You’ll likely be given other medications, such as heparin, to make your blood less likely to form clots. IV or injectable heparin usually is given during the first few days after a heart attack. […] Medical procedures to treat cardiogenic shock usually focus on restoring blood flow through your heart. […] If a blockage is found during a cardiac catheterization, your doctor can insert a long, thin tube (catheter) equipped with a special balloon through an artery, usually in your leg, to a blocked artery in your heart.

• #11 Cardiogenic Shock Treatment & Management: Approach Considerations, Prehospital Care, Resuscitation, Ventilation, and Pharmacologic Intervention

  https://emedicine.medscape.com/article/152191-treatment

  Placement of a central line may facilitate volume resuscitation, provide vascular access for multiple infusions, and allow invasive monitoring of central venous pressure. […] When immediate stabilization is necessary for recovery of cardiac and other organ systems, consider placing a temporary over durable mechanical circulatory support device (MCS) as the first-line device. […] An early revascularization strategy with either PCI or CABG, in collaboration between cardiologists and surgeons, is recommended for appropriate patients with suspected cardiogenic shock related to acute coronary syndrome. […] The SHOCK trial demonstrated that either PCI or CABG is the treatment of choice for cardiogenic shock and that each has been shown to markedly decrease mortality rates at 1 year. […] The 2019 American Heart Association (AHA) scientific statement on contemporary management of cardiogenic shock suggests that all patients with cardiogenic shock without serious bleeding complications continue post-PCI dual antiplatelet therapy without interruption.

• #12 Cardiogenic Shock

  https://www.rwjbh.org/treatment-care/heart-and-vascular-care/diseases-conditions/cardiogenic-shock/

  Cardiogenic shock treatment focuses on minimizing the damage from lack of oxygen to your heart muscle and other organs. Some treatment options include medications and medical and surgical procedures. […] Aspirin will treat pain and inflammation, and reduce risk of a heart attack. Thrombolytic therapy is the administration of drugs called lytics or clot busters that will help break up or dissolve blood clots. Anticoagulants blood-thinners will help treat, prevent and reduce blood clotting. Other antiplatelet drugs such as brilinta and prasugrel. Statins will help reduce the level of cholesterol in the blood. Any combination of the above. […] Angioplasty, Stent placement, Coronary artery bypass grafting (CABG), Ventricular assist device (VAD), Heart transplantation, Extracorporeal membrane oxygenation (ECMO).

• #13 Cardiogenic Shock Medication: Inotropic Agents, Vasodilators, Antiplatelet Agents, Cardiovascular, Opioid Analgesics, Diuretics, Loop, Cardiovascular, Other

  https://emedicine.medscape.com/article/152191-medication

  Vasodilators decrease preload and/or afterload. […] This agent causes relaxation of vascular smooth muscle by stimulating intracellular cyclic guanosine monophosphate production. The result is a decrease in preload and blood pressure (ie, afterload). […] Agents that irreversibly inhibit platelet aggregation may improve morbidity. […] Aspirin may be used at a low dose to inhibit platelet aggregation and improve complications of venous stasis and thrombosis. It reduces the likelihood of myocardial infarction (MI) and is also very effective in reducing the risk of stroke. Early administration of aspirin in patients with acute MI may reduce cardiac mortality in the first month. […] Analgesics reduce pain, which decreases sympathetic stress and provides some preload reduction. […] These drugs cause diuresis to decrease plasma volume and edema and thereby decrease cardiac output and, consequently, blood pressure. The initial decrease in cardiac output causes a compensatory increase in peripheral vascular resistance. With continuing diuretic therapy, extracellular fluid and plasma volumes return almost to pretreatment levels. Peripheral vascular resistance decreases below that of the pretreatment baseline.

• #14 Cardiogenic Shock: Causes, Symptoms, Treatment | Doctor

  https://patient.info/doctor/cardiogenic-shock

  Provide symptom relief if needed – eg, opiate analgesia. […] Treat any electrolyte abnormalities. […] Treat any arrhythmias. […] Treat any underlying causes – eg, usual management of acute MI, urgent valve repair. […] Vasopressor/inotropic medications used include dopamine, dobutamine, enoximone, and milrinone. […] Although inotropes increase cardiac output, they may also increase mortality due to increased tachycardia and myocardial oxygen consumption leading to arrhythmia and myocardial ischaemia. […] At present, there are no convincing data supporting any specific inotropic or vasodilating therapy to reduce mortality in haemodynamically unstable patients with cardiogenic shock and low cardiac output. […] IABP counterpulsation increases cardiac output and improves coronary artery blood flow.

• #15

  https://link.springer.com/article/10.1007/s11936-006-0028-4

  Cardiogenic shock, a devastating consequence of acute myocardial infarction, is associated with extremely high mortality. Treatment strategies should focus on prompt reperfusion and hemodynamic support. The primary approach for therapy is emergent angiography and revascularization using percutaneous coronary intervention or coronary artery bypass surgery, with the assistance of intra-aortic balloon pump counterpulsation. Several adjunctive pharmacologic agents, particularly inotropic drugs and vasopressors, are also helpful for hemodynamic support. However, these agents have not been shown to provide a survival benefit, and their use is primarily based on clinical experience. […] Newer therapeutic strategies, including C5 inhibitors and nitric oxide synthase inhibitors, are being combined with traditional strategies, such as inotropic agents, vasopressors, and circulatory assist, to treat cardiogenic shock.

• #16 Cardiogenic Shock – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482255/

  An experienced interprofessional team should evaluate MCS. […] IABP (Intra-aortic balloon pump) is the most commonly used and least expensive of all mechanical support devices. […] Early referral to a palliative care specialist is recommended as a strategy to reduce physical and emotional distress, optimize symptom control, and improve quality of life. […] Current Management Guidelines include immediate transfer for PCI, consider open heart surgery if PCI not available, start fibrinolytic therapy if PCI and open surgery not available, do not start beta-blockers, may use an IABP to stabilize the patient, consider LV assist device if no contraindications.

• #17 Cardiogenic shock – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cardiogenic-shock/diagnosis-treatment/drc-20366764

  Your doctor inserts a balloon pump in the main artery off of your heart (aorta). The pump inflates and deflates within the aorta, helping blood flow and taking some of the workload off your heart. […] Extracorporeal membrane oxygenation (ECMO) helps improve blood flow and supplies oxygen to the body. […] If medications and other procedures don’t work to treat cardiogenic shock, your doctor might recommend surgery. […] This surgery uses a healthy blood vessel in your leg, arm or chest to create a new pathway for blood so it can flow around a blocked or narrowed artery. […] Sometimes an injury, such as a tear in one of your heart’s chambers or a damaged heart valve, can cause cardiogenic shock. Surgery might correct the problem. […] A mechanical device can be implanted into the abdomen and attached to the heart to help it pump. […] If your heart is so damaged that no other treatments work, a heart transplant may be a last resort.

• #18 Cardiogenic Shock – Treatment | NHLBI, NIH

  https://www.nhlbi.nih.gov/health/cardiogenic-shock/treatment

  You may need a medical device to aid, bring back, or maintain blood flow. This can help prevent organ damage from cardiogenic shock. […] An extracorporeal membrane oxygenation (ECMO) device temporarily replaces the function of the heart and lungs by circulating the blood and supplying oxygen to the body’s organs. […] An intra-aortic balloon pump (IABP) may improve survival when used with ECMO device. […] Percutaneous circulatory assist devices (PCADs), including ventricular assist devices (VADs), can help support the heart until it recovers or while waiting for a heart transplant. […] Continuous kidney dialysis filters waste out of the blood if the kidneys are damaged. […] Fluids given through an intravenous (IV) line inserted in one of the blood vessels can maintain normal blood volumes. […] Mechanical breathing support, such as a ventilator, can protect the airway and provide extra oxygen. […] Oxygen therapy can help more oxygen reach the lungs, the heart, and the rest of the body.

• #19 Management of cardiogenic shock | EuroIntervention

  https://eurointervention.pcronline.com/article/management-of-cardiogenic-shock

  The Central illustration provides a general overview of the necessary steps in assessment and management of the AMI-CS patient. […] Where local protocol and logistical feasibility allow, patients with CS should be treated at specialised tertiary CS care centres, with the ability to start and escalate MCS, and dedicated cardiac ICU and cardiac surgery facilities on site. […] Although nowadays the results of the SHOCK trial, which compared early revascularisation with initial medical stabilisation, may be viewed in a different light in that it failed to meet its primary 30-day endpoint of decreased mortality in the early revascularisation group compared to the medically managed group, the long-term results showing reduced mortality at 6 months, 1 year and 6 years, as well as the evidence borne out in subsequent registries, appear to justify the Class IB recommendation for early revascularisation.

• #20 Cardiogenic Shock Treatment Options | Temple Health

  https://www.templehealth.org/services/conditions/cardiogenic-shock/treatment-options

  If medications are not enough to stabilize cardiogenic shock, your doctor may use one of the following temporary support devices to help restore proper blood flow: Intra-aortic balloon pump is placed in the aortic artery (the main artery of your heart) and provides an extra push to help move blood coming out of your heart. Other short term devices that are used to treat cardiogenic shock include: Impella, Tandem heart and extra corporeal membrane oxygenation (ECMO). […] Once the cause of cardiogenic shock has been determined, your doctor may perform one of the following procedures to treat the problem: Bypass surgery is a common approach that surgeons use to create new routes through which blood can flow around blocked or narrowed arteries. These bypasses are created using healthy vessels taken from the chest (mammary), arms (radial) or legs. Balloon angioplasty is used to open blocked coronary vessels. During this minimally invasive procedure, a catheter (thin, flexible tube) is guided into the blocked artery and a tiny balloon is inflated to clear the way so that blood flow is restored. In some cases, a stent (small mesh tube) is inserted to keep the artery open.

• #21 Cardiogenic shock – Wikipedia

  https://en.wikipedia.org/wiki/Cardiogenic_shock

  An intra-aortic balloon pump is a device placed by a cardiac surgeon into the descending aorta. It consists of a small balloon filled with helium that helps the heart to pump blood by inflating during diastole (the resting phase of the cardiac cycle) and deflating during systole (the contracting phase of the cardiac cycle). […] There are several types of left ventricular assist devices, with the Impella devices being some of the most common. This device is placed by a cardiac surgeon into the left ventricle of the heart and essentially acts as a pump, drawing blood from the left ventricle and pushing it out into the aorta so that it could be delivered to the rest of the body. […] Venous-arterial extra-corporeal membrane oxygenation is a circuit support system that is meant to replace the function of the heart as it heals or awaits a more definitive treatment.

• #22

  https://med.uth.edu/heartandvascular/programs/cardiogenic-shock/

  The timely treatment of patients with cardiogenic shock is essential to reestablish perfusion, which is the vital process of delivering blood to the body’s organs. This approach is crucial for preventing further decline and allowing the heart to recover. […] At UTHealth Houston, we deploy mechanical circulatory support devices as needed, either to provide temporary assistance to the heart during the recovery process or as a bridge towards long-term therapies, which may encompass heart transplantation. Evidence shows that prompt intervention with mechanical support, when appropriately indicated for cardiogenic shock patients, significantly enhances patient outcomes. […] The cardiogenic shock team at UTHealth Houston is the ideal point of contact for patients who exhibit sustained hypotension (systolic blood pressure [BP] less than 90 mm Hg for over 30 minutes), signs of tissue hypoperfusion, including a cool periphery (extremities cooler than the core), oliguria (30 mL/h), or both, and inadequate left ventricular (LV) filling pressure. […] Our dedicated team efficiently evaluates and prioritizes patients, ensuring prompt and focused care. […] We believe in personalized medicine, and each patient receives a uniquely tailored treatment plan designed to address their specific needs.

• #23 Cardiogenic Shock: Risk Factors, Causes and Symptoms

  https://my.clevelandclinic.org/health/diseases/17837-cardiogenic-shock

  Once you’ve received immediate emergency treatment, additional treatment depends on the cause of your cardiogenic shock. […] If you’re having a heart attack: Angioplasty and possibly a stent placement to help blood get through a blood vessel with a buildup of plaque (cholesterol and fat). […] If there’s a valve problem: Heart valve repair or replacement. […] If you have fluid around your heart: A procedure that uses a needle to remove excess fluid compressing your heart. […] If you have several blocked coronary arteries: Coronary artery bypass graft (open heart surgery) to help more blood get to your heart. […] If your heart remains too sick despite other treatments, you may require a machine that temporarily takes the workload from your heart and lungs (ECMO or extracorporeal membrane oxygenation). In addition to ECMO, placing a temporary pump in your aorta can help your heart pump more blood. […] If your heart function isn’t expected to improve, your healthcare team may evaluate you for a left ventricular assist device (LVAD, a long-term device to support your heart) or a heart transplant.

• #24 Cardiogenic Shock | Division of Cardiology

  https://www.columbiacardiology.org/patient-care/center-advanced-cardiac-care-heart-failure-lvad-transplant/conditions-and-treatments/cardiogenic-shock

  Patients with cardiogenic shock require prompt treatment in order to restore blood flow to vital organs. Treatment can include any or all of the following: […] Intravenous medications can help to increase the hearts pumping function and raise blood pressure to improve the blood flow. […] Angioplasty and stenting of heart arteries can restore blood flow to the heart muscle. However, many patients will continue to worsen despite these treatments. […] Mechanical circulatory support devices may be required to stabilize the patient. These devices include miniaturized heart pumps that can be placed through large blood vessels and extracorporeal membrane oxygenation (ECMO) in which an externalized heart pump circulates oxygenated blood to the body. Treating a cardiogenic shock patient with mechanical circulatory support devices give the heart time to recover or bridge the patient to either a long-term heart assist device called an LVAD (left ventricular assist device) or heart transplantation.

• #25 Experts’ recommendations for the management of adult patients with cardiogenic shock | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-015-0052-1

  In adults presenting severe aortic stenosis associated with cardiogenic shock, the aortic stenosis should be managed, probably by valvuloplasty and if need be, under ECMO (strong agreement). […] In adults presenting with aortic or mitral insufficiency responsible for cardiogenic shock, the valve should be replaced without delay (strong agreement). […] It is possible to use milrinone or levosimendan as an alternative to dobutamine in second-line treatment of cardiogenic shock after cardiac surgery (weak agreement). […] Knowledge of the causal mechanism(s) (hypovolemia, vasodilation, altered contractility) is essential for adaptation of treatment. Emergency echocardiography is mandatory, followed by continuous measurement of cardiac output and SvO2 (strong agreement). […] Patients with severe chronic heart disease should be assessed for their heart transplant eligibility in a center equipped for this intervention (strong agreement).

• #26 Cardiogenic Shock Treatment Options | Temple Health

  https://www.templehealth.org/services/conditions/cardiogenic-shock/treatment-options

  One of the following procedures may be used to restore normal heart rhythm: Cardioversion is like a quick reset of the heart and is very effective for getting the heart back to its normal rhythm. Unfortunately is does not prevent the possibility of future arrhythmias. During this procedure a quick electrical shock is delivered to the heart using two large sticky pads that are placed on the chest and back. The shock also causes the muscles of the chest to suddenly contract, so it is done under anesthesia to avoid any pain or discomfort. Pacemaker is a small electrical device that is implanted under the skin, usually just below the collar bone in the chest, and is attached to one, two, or three small electrical wires that are threaded into a vein and then inside the heart. An electrical pacemaker is usually used to treat an abnormally slow heartbeat that causes symptoms (such as lightheadedness, fatigue, inability to exercise, shortness of breath, or fainting), or a very slow heartbeat that could be dangerous. Sometimes a special 3-wire pacemaker system is used to re-coordinate a heart that is beating in an uncoordinated way. A new type of extra small pacemaker is being studied, which does not have any wires but instead is a small metal capsule that is implanted inside the heart itself. Catheter Ablation is a minimally invasive procedure where several thin wires are threaded into the veins and/or arteries in the groin, and guided inside the heart to perform very detailed electrical testing of the heart. When abnormal electrical spots or short-circuits are identified, very precise heating or freezing techniques can be used to permanently eliminate the problem spots to cure or manage the fast or irregular heartbeat. Catheter ablation can be used to control symptoms, reduce the need for medications and provide a better quality of life for a wide range of electrical problems (arrhythmias). Many different high-tech tools are used during an ablation to give the doctor extremely detailed pictures and images to pinpoint the problem(s) and direct the very precise work that is done inside the beating heart. […] In some cases, the underlying problem may result from a heart defect or failure. In these cases, valve repair/replacement surgery, mechanical circulatory support, or heart transplantation may be required.

• #27 Shock – Critical Care Medicine – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/critical-care-medicine/shock-and-fluid-resuscitation/shock

  In obstructive shock, nontraumatic cardiac tamponade requires immediate pericardiocentesis, which can be done at the bedside. […] Massive pulmonary embolism resulting in shock is treated with anticoagulation and thrombolysis, surgical embolectomy, or extracorporeal membrane oxygenation in select cases.

• #28 Treatment | SCAI – Seconds Count

  https://www.secondscount.org/condition/cardiogenic-shock/treatment

  If your CS is caused by an injury, surgical repair might be your best option. […] CABG is a surgical treatment in which doctors graft a vein from a leg (or another part of your body) to your coronary artery to enable blood to bypass a blockage and continue to supply blood flow to your heart muscle. Your doctor might suggest this surgery to you after youve had a heart attack and your heart has had time to recover. […] If all other treatment options have failed and youve reached end-stage heart failure, your last option may be having a heart transplant.

• #29 Review: Cardiogenic Shock Treatment Networks (Shock Team)

  https://www.uscjournal.com/articles/cardiogenic-shock-protocols-teams-centers-and-networks?language_content_entity=en

  The mortality of cardiogenic shock (CS) remains unacceptably high. […] Delays in recognition of CS and access to disease-modifying or hemodynamically stabilizing interventions likely contribute to the significant lethality of CS. […] Depending on the clinical phenotype of CS, a wide array of interventions, from coronary revascularization, percutaneous or surgical correction of structural heart disease through to mechanical circulatory support (MCS) adjunctive to critical care management, may be required to maintain life-sustaining physiology. […] The ideal service would deliver evidence-based or best-practice care efficiently, effectively, and reliably, with equity of access for patients and referrers alike. Care would be multidisciplinary and ideally longitudinal, from resuscitation through to rehabilitation.

• #30 Review: Cardiogenic Shock Treatment Networks (Shock Team)

  https://www.uscjournal.com/articles/cardiogenic-shock-protocols-teams-centers-and-networks?language_content_entity=en

  Regional networks of CS care are emerging. […] The reliability of escalation to definitive care is ensured by locally developed protocols, with integration of consensus-guideline best practices to ensure timely and appropriate escalation and de-escalation of care, specifically relating to the use of MCS technologies, and mitigation of complications. […] The concept of team-based cardiovascular care is not novel, and heart teams currently support decision making in a range of elective cardiac interventions. […] A core team of specialists, the shock team, is essential for time-critical decision making, supported by a wider team to ensure holistic follow-on care. […] The optimal composition of the shock team will depend on local resources, but contemporary shock teams typically comprise an interventional cardiologist, a cardiac critical care physician, cardiac critical care nurses, an advanced heart failure cardiologist, and a cardiac surgeon.

• #31 Review: Cardiogenic Shock Treatment Networks (Shock Team)

  https://www.uscjournal.com/articles/cardiogenic-shock-protocols-teams-centers-and-networks?language_content_entity=en

  The role of the shock team is to facilitate specific interventions tailored to the etiology of CS and real-time patient physiology, provide expertise that supports locally approved escalation protocols for MCS, and efficiently triage patients to an appropriate care location. […] Both European Society of Cardiology and American Heart Association guidelines recommend that patients with CS refractory to first-line therapies undergo evaluation for temporary MCS by a clinical team with experience in MCS technologies. […] A number of healthcare systems in North America have described the development of shock teams and associated escalation protocols to streamline care and improve outcomes in patients with CS. […] The introduction of a telephone-activated multidisciplinary shock team at the Inova Heart and Vascular Institute in Virginia, accompanied by an institutional protocol for CS management, was associated with a reduction in 30-day mortality from 53% to 23%.

• #32 Cardiogenic Shock Program | Stony Brook Heart Institute

  https://heart.stonybrookmedicine.edu/cs

  Cardiogenic shock is a life-threatening condition in which your heart is suddenly unable to pump as much blood as your body needs. It is a complex condition that requires immediate intervention. […] On a moments notice, our Cardiogenic Shock (CS) Program brings together experts in advanced cardiac care, including critical care, heart failure, interventional cardiology and cardiac surgery to care for these patients with early optimization of advanced treatment. […] When every minute counts, leading-edge protocols and technology in the hands of our expert cardiogenic shock team facilitate critical lifesaving care. […] Having a multidisciplinary team of advanced heart specialists involved in every phase of a cardiogenic shock patients care means we are able to identify and implement the most appropriate treatment in the shortest amount of time.

• #33 Review: Cardiogenic Shock Treatment Networks (Shock Team)

  https://www.uscjournal.com/articles/cardiogenic-shock-protocols-teams-centers-and-networks?language_content_entity=en

  A longer-term survival benefit was also reported from the introduction of a smartphone-activated shock team at the University of Ottawa, which was associated with a reduction in 8-month mortality from 67% to 43%. […] Although the majority of clinical decision making may be conducted by the core team, the involvement of the wider patient care team cannot be underestimated. […] The role of shock teams may be to synthesize and analyze a locally (or regionally) defined minimum dataset of clinical, biochemical, imaging, and physiological parameters to guide the optimal timing of escalation to MCS, as well as device and patient selection. […] Mortality in cardiogenic shock remains unacceptably high. […] A multidisciplinary protocolized team-based approach with regional hub-and-spoke networks of care built around high-volume, experienced centers is likely to improve outcomes.

• #34 Cardiogenic Shock Treatment | Froedtert & MCW

  https://www.froedtert.com/stories/cardiogenic-shock-protocol-improves-patient-outcomes

  When more advanced medical intervention is needed, our Cardiogenic Shock Team can provide patients with the full scope of mechanical circulatory devices to either temporarily support the heart as it recovers or serve as a bridge to surgical intervention to correct the problem within the heart. […] Surgical interventions are often considered essential measures to address underlying heart issues that cause or contribute to cardiogenic shock. When further medical care is needed, our team of physicians may perform a surgical intervention to correct the problem within your heart. […] Each of these procedures is designed to comprehensively address specific heart conditions contributing to cardiogenic shock, thus enhancing patient outcomes by promoting cardiac recovery and stability. […] With the implementation of the cardiogenic shock process at Froedtert Hospital, we are now achieving survival rates of 78%. […] To improve a patients chances of survival, our team advises referring physicians to make shock calls early. Early activation leads to the best possible outcomes.

• #35 Cardiogenic Shock | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/cardiogenic-shock

  Cardiogenic shock can be fatal if not treated immediately. But even in severe cases, about half the people who develop cardiogenic shock can survive if they’re treated promptly with modern therapies. […] The goal of cardiogenic shock treatment is to quickly restore blood pressure and heart function. This often requires immediate treatments that are given in an ambulance or the emergency room. Other treatments may include medications or temporary support devices to restore blood flow. Longer-term therapies could address the underlying condition that caused the heart to stop pumping enough blood. […] Emergency treatments may include oxygen delivered via a tube or mask, breathing assistance using a ventilator, intravenous (IV) fluids and medications to support blood pressure or heart function.

• #36 Management of cardiogenic shock: a narrative review | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01260-y

  Cardiogenic shock (CS) is characterized by low cardiac output and sustained tissue hypoperfusion that may result in end-organ dysfunction and death. CS is associated with high short-term mortality, and its management remains challenging despite recent advances in therapeutic options. Timely diagnosis and multidisciplinary team-based management have demonstrated favourable effects on outcomes. […] The cornerstone of treatment that improved CS prognosis in AMI patients is emergent coronary revascularization (or Percutaneous Coronary Intervention PCI) in patients with coronary artery disease. […] The management of CS has seen significant advances in recent decades, but the mortality remains dramatically high. As for other types of shock, rapid recognition with multimodal evaluation by ECG, biological and echocardiographic tests allows early and appropriate management and may improve survival. Recent classifications allowing better stratification of mortality risk may be useful to guide the management. The cornerstone of CS patient management is the treatment of the cause of the cardiac insult including coronary revascularization by PCI of the culprit lesion in case of AMI. Symptomatic management aims to restore perfusion with noradrenaline and increase cardiac output with inotropic therapies. The management of other organs failure is based on optimization of mechanical ventilation and appropriate initiation of RRT. Mechanical assist devices may have an important role in CS patients but, pending the results of further clinical trials, the type and implantation timing of such techniques remain to be defined according to the expertise of the Heart Team.

• #37 Management of cardiogenic shock | EuroIntervention

  https://eurointervention.pcronline.com/article/management-of-cardiogenic-shock

  Despite the rapidly evolving evidence base in modern cardiology, progress in the area of cardiogenic shock remains slow, with short-term mortality still reaching 40-50%, relatively unchanged in recent years. […] With only definitive evidence for early revascularisation and the relative ineffectiveness of intra-aortic balloon pumping, most aspects of patient management are based on expert consensus, rather than randomised controlled trials. […] This updated 2020 review will outline the management of CS mainly after acute myocardial infarction with major focus on state-of-the-art treatment based on randomised clinical trials or matched comparisons if available. […] The underlying causes, pathophysiology, and treatment of AMI-CS have been reviewed previously. This 2020 update will focus on evidence-based therapeutic management of AMI-CS with major emphasis on current guideline recommendations, revascularisation strategies, intensive care unit (ICU) treatment, adjunctive medication, and mechanical circulatory support (MCS) devices.

• #38 Cardiogenic shock: Causes, symptoms, and treatment

  https://www.medicalnewstoday.com/articles/cardiogenic-shock

  Cardiogenic shock is a medical emergency and requires immediate treatment. The aim of treatment is to restore blood flow to the brain and other organs as quickly as possible to protect them from damage. […] Treatments may include heart procedures or other surgeries, depending on the persons condition when treatment begins. […] Treatments may include: intravenous fluids, heart catheterization for coronary angiography, oxygen supplementation, mechanical ventilation, mechanical circulatory support (MCS) devices, medicines, such as vasopressors, to contract blood vessels and raise blood pressure. […] Other treatments may need to focus on preventing or treating damage to other organs. […] Even with modern advances, treatment is still challenging. […] Prompt treatment of cardiogenic shock is crucial to give the person the best chance to survive and avoid damage to the organs or organ failure. Even with proper treatment, the risk of mortality is high.

• #39 Cardiogenic Shock | Inova

  https://www.inova.org/our-services/inova-schar-heart-and-vascular/conditions-treatments/cardiogenic-shock

  Cardiogenic shock occurs when the heart cannot pump enough blood to meet the bodys needs. […] Not every heart attack results in cardiogenic shock but, for those instances when it occurs, emergency treatment to improve the flow of blood and oxygen is essential. […] Each stage requires selective and tailored treatments to improve blood flow and oxygen throughout the body. […] A single phone call connects specialists from interventional cardiology, cardiovascular surgery, advanced heart failure, critical care, and emergency medicine to quickly gather information and recommend the best treatment for these critically ill patients. […] Early hemodynamic assessment and expedited initiation of mechanical circulatory support such as ECMO, Impella heart pump, etc. […] About one in 10 people who experience a heart attack develop cardiogenic shock, which is associated with a mortality rate exceeding 50 percent in the United States. […] Survival rates at Inova are consistently better than the national average thanks to our innovative multispecialty Shock Team. […] Implementing a dedicated, fast-acting team has improved outcomes and saved lives.

• #40 Review of Advancements in Managing Cardiogenic Shock: From Emergency Care Protocols to Long-Term Therapeutic Strategies

  https://www.mdpi.com/2077-0383/13/16/4841

  Invasive monitoring is advisable to confirm the hemodynamic phenotype, ascertain left and right filling pressures, complete prognostic assessment, and guide therapeutic strategies. […] The therapeutic goals in CS should be restoring tissue perfusion and organ function, facilitating recovery of cardiac function, or, in the absence of adequate recovery, bridging to an “Exit Therapy.”

• #41

  https://link.springer.com/article/10.1007/s00134-024-07618-x

  The most common way to optimize preload is fluid management. Targeting pharmacological decongestion through enhanced salt and water excretion is a rational approach to improve outcomes and symptoms. […] Afterload depends primarily on resistance vessels and left-ventricular wall stress. Vasopressors are the primary agents for stabilizing systemic vascular resistance by increasing blood pressure, aiming to enhance perfusion to vital organs in CS particularly through raising diastolic pressure for improved coronary artery perfusion. […] Pharmacologic management of CS can be divided into specific-causal and supportive drugs. […] Temporary mechanical circulatory support is a potential option for enhancing end-organ perfusion in patients with de novo or refractory CS. […] The role of VA-ECMO in AMICS would be limited to patients with concomitant severe respiratory failure, biventricular failure, or cardiac arrest. […] Current management of CS is resource intensive and falls behind expectations with respect to outcomes.

• #42

  https://link.springer.com/article/10.1007/s00134-024-07618-x

  The management of cardiogenic shock is an ongoing challenge. Despite all efforts and tremendous use of resources, mortality remains high. […] This review provides a comprehensive overview of contemporary management that includes pharmacologic therapy as well as the use of mechanical circulatory support and gives an outlook to support a more personalized medicine beyond the syndromic approach of cardiogenic shock. […] Causal treatments aim at correcting the underlying pathology and include acute surgical or percutaneous valve interventions in, for example, acute aortic regurgitation in bacterial endocarditis or acute mitral regurgitation. In most cases of CS, stabilization with vasopressors and inotropes while continuously assessing the need for MCS or heart transplantation remains the most common clinical strategy.

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