Optimal Perfusion Targets in Cardiogenic Shock

Abstract

Cardiology shock is a syndrome of low cardiac output resulting in end-organ dysfunction. Few interventions have demonstrated meaningful clinical benefit, and cardiogenic shock continues to carry significant morbidity with mortality rates that have plateaued at upwards of 40% over the past decade. Clinicians must rely on clinical, biochemical, and hemodynamic parameters to guide resuscitation. Several features, including physical examination, renal function, serum lactate metabolism, venous oxygen saturation, and hemodynamic markers of right ventricular function, may be useful both as prognostic markers and to guide therapy. This article aims to review these targets, their utility in the care of patients with cardiology shock, and their association with outcomes.

Keywords: cardiogenic shock; lactate; mean arterial pressure; resuscitation; target.

Graphical abstract

Central Illustration

Clinical, Biochemical, and Hemodynamic Variables This figure highlights clinical, biochemical, and hemodynamic parameters that are commonly trending in the ongoing management of patients with cardiogenic shock. Arrows identify the direction of change in states of clinical deterioration. BP = blood pressure; CI = cardiac index; CPA = pulmonary artery compliance; CPO = cardiac power output; CRT = capillary refill time; eGFR = estimated glomerular filtration rate; HR = heart rate; JVP = jugular venous pressure; LC = lactate clearance; LVEDP = left ventricular end-diastolic pressure; MAP = mean arterial pressure; P(v-a)CO₂ gap = venous arterial carbon dioxide gap; PAPi = pulmonary artery pulsatility index; PetCO₂ = end-tidal CO₂; sBP = systolic blood pressure; ScvO₂ = central venous oxygen saturation; SvO₂ = mixed venous oxygen saturation.