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. 2013 Aug;8(2):73-80.
doi: 10.15420/icr.2013.8.2.73.

Evidence-based Management of Cardiogenic Shock After Acute Myocardial Infarction

Karl Werdan  1 , Martin Russ  2 , Michael Buerke  3 , Roland Prondzinsky  4 , Sebastian Dietz  1
Affiliations

Evidence-based Management of Cardiogenic Shock After Acute Myocardial Infarction

Karl Werdan et al. Interv Cardiol. 2013 Aug.

Abstract

Guidelines for evidence-based management of patients with cardiogenic shock after acute myocardial infarction focuses on early revascularisation of the occluded coronary artery as well as on support of cardiac failure and improvement of impaired organ perfusion. Also of great importance is effective treatment of shock complications, especially acute respiratory failure and other forms of multiple organ dysfunction syndrome (MODS). Cardiovascular therapy has to be accompanied by best general intensive care of these critically ill patients with high mortality. Most lives can be saved by early revascularisation, and this class I recommendation has a high level of evidence. So far, most of the other guideline recommendations are of low evidence level, in most cases based on expert opinions. Recently, the Intra-aortic Balloon Pump in Cardiogenic Shock II (IABP SHOCK II) trial with 600 patients has shown that adjunctive IABP therapy - for long a class I recommendation - does not reduce 30-day and six-month motality.

Keywords: Cardiogenic shock; German-Austrian cardiogenic shock guideline; IABP SHOCK II trial; blood glucose; dobutamine; guideline; lung protective ventilation; multiple organ dysfunction syndrome; myocardial infarction; norepinephrine; percutaneous coronary intervention.

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Conflict of interest statement

Disclosure: Karl Werdan was the coordinator of the German-Austrian S3 guideline, “Cardiogenic Shock Due to Myocardial Infarction: Diagnosis, Monitoring and Treatment” and Martin Russ and Michael Buerke were also authors of this guideline. The remaining authors have no conflicts of interests to declare.

Figures

Figure 1:
Figure 1:. What Determines Survival in Cardiogenic Shock (Left Ventricular Pump Failure) Complicating Myocardial Infarction?
Figure 2:
Figure 2:. Recommendations of the European (Upper Part) and American (Lower Part) Guidelines for the Treatment of Cardiogenic Shock Complicating Acute Myocardial Infarction
Figure 3:
Figure 3:. A Selection of Recommendations of the German-Austrian S3 Guideline “Cardiogenic Shock Complicating Myocardial Infarction”
Figure 4:
Figure 4:. Algorithm – Revascularisation in Patients with Cardiogenic Shock Complicating Acute Myocardial Infarction
Figure 5:
Figure 5:. Algorithm – Haemodynamic Shock Therapy
Figure 6:
Figure 6:. Adjunctive IABP Therapy of Patients with Cardiogenic Shock Complicating Acute Myocardial Infarction and Early Revascularisation (IABP SHOCK Trial) – Effects on Haemodynamics
Figure 7:
Figure 7:. IABP-SHOCK II Trial – Effect of Adjunctive IABP Treatment on 30-day and Six-month Mortality of Patients with Cardiogenic Shock Complicating Myocardial Infarction and Early Revascularisation
Figure 8:
Figure 8:. Algorithm – Ventilation and Treatment of Multiple Organ Dysfunction Syndrome
See this image and copyright information in PMC

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