Therapeutic Advances in the Management of Cardiogenic Shock

Ovidiu Chioncel, Sean P. Collins, Andrew P. Ambrosy, Peter Pang, Razvan I. Radu, Elena Laura Antohi, Josep Masip, Javed Butler, Vlad Anton Iliescu

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Cardiogenic shock (CS) is a life-threatening state of tissue hypoperfusion, associated with a very high risk of mortality, despite intensive monitoring and modern treatment modalities. The present review aimed at describing the therapeutic advances in the management of CS. AREAS OF UNCERTAINTY: Many uncertainties about CS management remain in clinical practice, and these relate to the intensity of invasive monitoring, the type and timing of vasoactive therapies, the risk-benefit ratio of mechanical circulatory support (MCS) therapy, and optimal ventilation mode. Furthermore, most of the data are obtained from CS in the setting of acute myocardial infarction (AMI), although for non-AMI-CS patients, there are very few evidences for etiological or MCS therapies. DATA SOURCES: The prospective multicentric acute heart failure registries that specifically presented characteristics of patients with CS, distinct to other phenotypes, were included in the present review. Relevant clinical trials investigating therapeutic strategies in post-AMI-CS patients were added as source information. Several trials investigating vasoactive medications and meta-analysis providing information about benefits and risks of MCS devices were reviewed in this study. THERAPEUTIC ADVANCES: Early revascularization remains the most important intervention for CS in settings of AMI, and in patients with multivessel disease, recent trial data recommend revascularization on a "culprit-lesion-only" strategy. Although diverse types of MCS devices improve hemodynamics and organ perfusion in patients with CS, results from almost all randomized trials incorporating clinical end points were inconclusive. However, development of new algorithms for utilization of MCS devices and progresses in technology showed benefit in selected patients. A major advance in the management of CS is development of concept of regional CS centers based on the level of facilities and expertise. The modern systems of care with CS centers used as hubs integrated with emergency medical systems and other referee hospitals have the potential to improve patient outcomes. CONCLUSIONS: Additional research is needed to establish new triage algorithms and to clarify intensity and timing of pharmacological and mechanical therapies.

Original languageEnglish (US)
Pages (from-to)e234-e247
JournalAmerican journal of therapeutics
Volume26
Issue number2
DOIs
StatePublished - Mar 1 2019

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Cardiogenic Shock
Therapeutics
Myocardial Infarction
Equipment and Supplies
Triage
Uncertainty
Ventilation
Registries
Meta-Analysis
Emergencies
Randomized Controlled Trials
Heart Failure
Perfusion
Hemodynamics
Odds Ratio
Clinical Trials
Pharmacology

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

Cite this

Chioncel, O., Collins, S. P., Ambrosy, A. P., Pang, P., Radu, R. I., Antohi, E. L., ... Iliescu, V. A. (2019). Therapeutic Advances in the Management of Cardiogenic Shock. American journal of therapeutics, 26(2), e234-e247. https://doi.org/10.1097/MJT.0000000000000920

Therapeutic Advances in the Management of Cardiogenic Shock. / Chioncel, Ovidiu; Collins, Sean P.; Ambrosy, Andrew P.; Pang, Peter; Radu, Razvan I.; Antohi, Elena Laura; Masip, Josep; Butler, Javed; Iliescu, Vlad Anton.

In: American journal of therapeutics, Vol. 26, No. 2, 01.03.2019, p. e234-e247.

Research output: Contribution to journalArticle

Chioncel, O, Collins, SP, Ambrosy, AP, Pang, P, Radu, RI, Antohi, EL, Masip, J, Butler, J & Iliescu, VA 2019, 'Therapeutic Advances in the Management of Cardiogenic Shock', American journal of therapeutics, vol. 26, no. 2, pp. e234-e247. https://doi.org/10.1097/MJT.0000000000000920
Chioncel, Ovidiu ; Collins, Sean P. ; Ambrosy, Andrew P. ; Pang, Peter ; Radu, Razvan I. ; Antohi, Elena Laura ; Masip, Josep ; Butler, Javed ; Iliescu, Vlad Anton. / Therapeutic Advances in the Management of Cardiogenic Shock. In: American journal of therapeutics. 2019 ; Vol. 26, No. 2. pp. e234-e247.
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