Intensive Care Management of the Cardiogenic Shock Patient

Abstract

Optimal management of patients with cardiogenic shock requires a detailed and systematic assessment of all organ systems, balancing the risks and benefits of any investigation and intervention, while avoiding the complications of critical illness. Overall prognosis depends upon a number of factors, including that of the underlying cardiac disease and its potential reversibility, the severity of shock, the involvement of other organ systems, the age of the patient and comorbidities. As with all intensive care patients, the mainstay of management is supportive, up to and including implementation and management of a number of devices, including acute mechanical circulatory support. The assessment and management of these most critically ill patients therefore demands in-depth knowledge and skill relating to cardiac intensive care, extending well beyond standard intensive care or cardiology practice.

Keywords: Cardiogenic shock; echocardiography; extracorporeal support.

Figure 1:. The Chain of Survival in Cardiogenic Shock

Figure 2:. Calculation of Total Isovolumic Time in a Critically Ill Cardiogenic Shock Patient

Figure 3:. Emergency Loss of Cardiac Output on Venoarterial Extracorporeal Membrane Oxygenation

Figure 4:. Suggested Protocols for Apnea Testing and Withdrawal of Life-sustaining Treatments on Extracorporeal Membrane Oxygenation