Ischaemic cardiogenic shock
Abstract: Ischaemia is the most common underlying cause of cardiogenic shock. Cardiogenic shock occurs in up to 10% of patients presenting with acute myocardial infarction and is the leading cause of death. Myocardial ischaemia results in both systolic and diastolic dysfunction and triggers a maladaptive feedback loop that can ultimately result in tissue hypoxia, multi-organ dysfunction and death. Myocardial dysfunction can be complicated by a systemic inflammatory response syndrome (SIRS) as a result of systemic hypoxia. Echocardiography is key to diagnosis and to exclude conditions requiring urgent surgical intervention. Serial assessment can be used to monitor response to interventions and/or complications. Resuscitative aims are immediate cardiorespiratory stabilization to facilitate urgent revascularization. Both pharmacological and mechanical supportive techniques are used. Mortality rates for patients who develop ischaemic cardiogenic shock remain high, and further research into strategies to prevent and treat the condition is required.
PATIENTS UNDERGOING cardiac surgery are at risk for cardiovascular collapse from a variety of pathologies including, but not limited to, hemorrhage, tamponade, myocardial infarction, arrhythmias, or cardiogenic shock. Tension pneumothorax is a rare complication after cardiac surgery and requires prompt recognition and treatment. The subsequent case report describes an occurrence of tension pneumothorax and hemodynamic instability after the use of an airway exchange catheter (AEC) to extubate and reintubate a patient with a difficult airway following cardiac surgery.
CARDIOGENIC SHOCK is a state of inadequate end-organ perfusion resulting from myriad causes, including ischemia, myocarditis, acute and chronic heart failure, postcardiotomy, and post-transplantation. It is the leading cause of death among patients experiencing acute myocardial infarction, with a mortality of 40% to 50%.1 Treatment generally includes revascularization for ischemia and supportive care with inotropes, vasopressors, and fluids as needed. Refractory cardiogenic shock is defined as ongoing hypoperfusion despite the administration of multiple vasoactive medications and treatment of the underlying cause.
CONCLUSION: In patients with cardiogenic shock after delivery, early transthoracic echocardiography is a non-invasive tool that can rapidly narrow the differential diagnosis. PMID: 31324480 [PubMed - as supplied by publisher]
DEVELOPED IN THE 1960s, the intra-aortic balloon bump (IABP) remains the most widely used mechanical circulatory assist device.1 It improves myocardial oxygen delivery and coronary perfusion for patients with acute myocardial infarction, in cardiogenic shock, or at high risk undergoing coronary artery bypass grafting (CABG). IABPs are placed in 5% to 10% of all cardiac surgical patients, and 16% of all IABPs are placed to aid in weaning from cardiopulmonary bypass.1,2 The IABP, however, is associated with numerous complications, including thrombocytopenia, fever, distal limb ischemia, thromboembolism, and balloon failure.
In this study, we evaluated a new RSI/mechanical ventilation protocol in patients with acute myocardial infarction complicated by cardiogenic shock.MethodsWe included consecutive adult patients who were transferred to the emergency department. The RSI protocol included 5 phases: preoxygenation, pretreatment, induction/paralysis, intubation, and mechanical ventilation (PPIIM). A posteriori, we selected historical patients managed with standard RSI as a control group. The primary outcome was hemodynamic derangement or hypoxemia from enrollment until intensive care unit (ICU) admission.ResultsWe studied 31 consecutive patient...
Conclusions The PPIIM protocol allows safe intubation of AMI patients with cardiogenic shock and improves hemodynamic and oxygenation parameters. Teaser This study evaluated a novel rapid sequence induction/ventilation protocol (PPIIM) in consecutive patients with acute myocardial infarction complicated by cardiogenic shock. Compared to historical controls who underwent standard rapid sequence induction, the PPIIM protocol allows safe intubation and improves hemodynamic and oxygenation parameters.
INTRA-AORTIC BALLOON PUMP (IABP) counterpulsation is the most commonly used mechanical circulatory support (MCS) device, especially for the following 3 subsets of medical conditions: cardiogenic shock, acute myocardial infarction, and high-risk percutaneous coronary intervention (PCI).1 The advantages of an IABP are improved coronary perfusion and decreased afterload; the drawbacks are potential limb ischemia and limited ambulation. Recently, new counterpulsation techniques and devices have been developed to address some of the disadvantages.
Despite a high rate of early revascularization and use of intra-aortic balloon pump counterpulsation therapy, the prognosis of patients with cardiogenic shock has remained poor. In the hopes of improving outcomes, clinicians are increasingly turning to percutaneous left and right mechanical circulatory support devices. Until recently, the evidence base for these devices had consisted only of observational data, meta-analyses, and small feasibility trials. In this article, we describe the contemporary outcomes of patients with cardiogenic shock, the hemodynamics of cardiogenic shock, and hemodynamic effects of percutaneous ...
CONCLUSION: In emergency situations with long transportation times to the nearest suitable cardiac catheterisation laboratory, preclinical fibrinolysis in STEMI still represents a workable method. Success of this strategy requires particularly strong training of the emergency physicians in ECG and lysis therapy, and co-operation with nearby cardiac centres. PMID: 27503306 [PubMed - as supplied by publisher]
Acute heart failure (AHF) due to acute myocardial infarction (AMI) is likely to involve cardiogenic shock (CS) when early revascularization is not efficient. CS is a state of end-organ hypoperfusion consecutive to cardiac failure with neuro-hormonal activation. The increase of vasopressin (AVP) release has been associated with adverse outcome in AHF (1). AVP may be responsible for microcirculation alterations with inadequate tissue oxygenation (2) leading to multiple organs failure and death. The aim of the experimental study was to investigate the implication of AVP, studied by in vitro vascular reactivity, in the alterat...