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Review
. 2023 May 6;13(1):38.
doi: 10.1186/s13613-023-01130-z.

Microcirculatory dysfunction in cardiogenic shock

Hamid Merdji  1   2 , Bruno Levy  3 , Christian Jung  4 , Can Ince  5 , Martin Siegemund  1   2 , Ferhat Meziani  6   7   8
Affiliations
Review

Microcirculatory dysfunction in cardiogenic shock

Hamid Merdji et al. Ann Intensive Care. .

Abstract

Cardiogenic shock is usually defined as primary cardiac dysfunction with low cardiac output leading to critical organ hypoperfusion, and tissue hypoxia, resulting in high mortality rate between 40% and 50% despite recent advances. Many studies have now evidenced that cardiogenic shock not only involves systemic macrocirculation, such as blood pressure, left ventricular ejection fraction, or cardiac output, but also involves significant systemic microcirculatory abnormalities which seem strongly associated with the outcome. Although microcirculation has been widely studied in the context of septic shock showing heterogeneous alterations with clear evidence of macro and microcirculation uncoupling, there is now a growing body of literature focusing on cardiogenic shock states. Even if there is currently no consensus regarding the treatment of microcirculatory disturbances in cardiogenic shock, some treatments seem to show a benefit. Furthermore, a better understanding of the underlying pathophysiology may provide hypotheses for future studies aiming to improve cardiogenic shock prognosis.

Keywords: Cardiogenic shock; Heart failure; Macrocirculation; Microcirculation; Perfusion parameters.

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Conflict of interest statement

Prof. Can INCE who is chief scientific officer of Medical BV, Leiden, The Netherlands, a company that provides devices, software, education, and services related to clinical microcirculation. All other authors have no disclosures.

Figures

Fig. 1
Fig. 1
Microcirculation structure and function. The organ vasculature system has been anatomically and functionally subclassified into macro and microcirculation. Macrocirculation is constituted by conduction arteries (such as the aorta) before entering the resistance arteries (such as the mesenteric arteries) with the main purpose of transporting blood. Microcirculation is composed of pre-arterioles and arterioles regulating blood flow, leading to capillaries allowing the exchange of gases, nutrients, hormones, and other molecules
Fig. 2
Fig. 2
Microcirculation alteration during cardiogenic shock. Alterations of microcirculation can be characterized by multiple different types of impairments, such as no capillary perfusion, low perfusion, heterogeneous perfusion, stasis, or shunting area. Besides, it can also be a result of hemodilution of microcirculatory blood by plasma skimming resulting in the loss of erythrocyte-filled capillaries which decreases tissue oxygen delivery. Or it can be secondary to edema caused by capillary leak syndrome (seen in critically ill patients) which results in increased diffusive distance and reduced ability of the oxygen to reach the tissue cells
Fig. 3
Fig. 3
Schematic time course of macro- and microcirculatory dysfunction in cardiogenic shock (adapted from Chioncel et al., 2020). While macrocirculatory dysfunction seems to predominate initially during CS, the microcirculation becomes progressively dysfunctional in a second phase. This can ultimately lead to a loss of hemodynamic coherence. MODS multiple organ dysfunction syndrome
See this image and copyright information in PMC

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