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Advances in the management of cardiogenic shock

Jacob C. Jentzer, Janine Pöss, HANNAH SCHAUBROECK (UGent) , David A. Morrow, Steven M. Hollenberg and Alexandre Mebazaa
(2023) CRITICAL CARE MEDICINE. 51(9). p.1222-1233
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Abstract
OBJECTIVES:To review a contemporary approach to the management of patients with cardiogenic shock (CS). DATA SOURCES:We reviewed salient medical literature regarding CS. STUDY SELECTION:We included professional society scientific statements and clinical studies examining outcomes in patients with CS, with a focus on randomized clinical trials. DATA EXTRACTION:We extracted salient study results and scientific statement recommendations regarding the management of CS. DATA SYNTHESIS:Professional society recommendations were integrated with evaluated studies. CONCLUSIONS:CS results in short-term mortality exceeding 30% despite standard therapy. While acute myocardial infarction (AMI) has been the focus of most CS research, heart failure-related CS now predominates at many centers. CS can present with a wide spectrum of shock severity, including patients who are normotensive despite ongoing hypoperfusion. The Society for Cardiovascular Angiography and Intervention Shock Classification categorizes patients with or at risk of CS according to shock severity, which predicts mortality. The CS population includes a heterogeneous mix of phenotypes defined by ventricular function, hemodynamic profile, biomarkers, and other clinical variables. Integrating the shock severity and CS phenotype with nonmodifiable risk factors for mortality can guide clinical decision-making and prognostication. Identifying and treating the cause of CS is crucial for success, including early culprit vessel revascularization for AMI. Vasopressors and inotropes titrated to restore arterial pressure and perfusion are the cornerstone of initial medical therapy for CS. Temporary mechanical circulatory support (MCS) is indicated for appropriately selected patients as a bridge to recovery, decision, durable MCS, or heart transplant. Randomized controlled trials have not demonstrated better survival with the routine use of temporary MCS in patients with CS. Accordingly, a multidisciplinary team-based approach should be used to tailor the type of hemodynamic support to each individual CS patient's needs based on shock severity, phenotype, and exit strategy.
Keywords
Critical Care and Intensive Care Medicine, shock, mechanical circulatory support, heart failure, cardiogenic shock, acute myocardial infarction

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MLA
Jentzer, Jacob C., et al. “Advances in the Management of Cardiogenic Shock.” CRITICAL CARE MEDICINE, vol. 51, no. 9, Ovid Technologies (Wolters Kluwer Health), 2023, pp. 1222–33, doi:10.1097/ccm.0000000000005919.
APA
Jentzer, J. C., Pöss, J., SCHAUBROECK, H., Morrow, D. A., Hollenberg, S. M., & Mebazaa, A. (2023). Advances in the management of cardiogenic shock. CRITICAL CARE MEDICINE, 51(9), 1222–1233. https://doi.org/10.1097/ccm.0000000000005919
Chicago author-date
Jentzer, Jacob C., Janine Pöss, HANNAH SCHAUBROECK, David A. Morrow, Steven M. Hollenberg, and Alexandre Mebazaa. 2023. “Advances in the Management of Cardiogenic Shock.” CRITICAL CARE MEDICINE 51 (9): 1222–33. https://doi.org/10.1097/ccm.0000000000005919.
Chicago author-date (all authors)
Jentzer, Jacob C., Janine Pöss, HANNAH SCHAUBROECK, David A. Morrow, Steven M. Hollenberg, and Alexandre Mebazaa. 2023. “Advances in the Management of Cardiogenic Shock.” CRITICAL CARE MEDICINE 51 (9): 1222–1233. doi:10.1097/ccm.0000000000005919.
Vancouver
1.
Jentzer JC, Pöss J, SCHAUBROECK H, Morrow DA, Hollenberg SM, Mebazaa A. Advances in the management of cardiogenic shock. CRITICAL CARE MEDICINE. 2023;51(9):1222–33.
IEEE
[1]
J. C. Jentzer, J. Pöss, H. SCHAUBROECK, D. A. Morrow, S. M. Hollenberg, and A. Mebazaa, “Advances in the management of cardiogenic shock,” CRITICAL CARE MEDICINE, vol. 51, no. 9, pp. 1222–1233, 2023.
@article{01H1NWAAYSMKGQ87S9Y53FM082,
  abstract     = {{OBJECTIVES:To review a contemporary approach to the management of patients with cardiogenic shock (CS). DATA SOURCES:We reviewed salient medical literature regarding CS. STUDY SELECTION:We included professional society scientific statements and clinical studies examining outcomes in patients with CS, with a focus on randomized clinical trials. DATA EXTRACTION:We extracted salient study results and scientific statement recommendations regarding the management of CS. DATA SYNTHESIS:Professional society recommendations were integrated with evaluated studies. CONCLUSIONS:CS results in short-term mortality exceeding 30% despite standard therapy. While acute myocardial infarction (AMI) has been the focus of most CS research, heart failure-related CS now predominates at many centers. CS can present with a wide spectrum of shock severity, including patients who are normotensive despite ongoing hypoperfusion. The Society for Cardiovascular Angiography and Intervention Shock Classification categorizes patients with or at risk of CS according to shock severity, which predicts mortality. The CS population includes a heterogeneous mix of phenotypes defined by ventricular function, hemodynamic profile, biomarkers, and other clinical variables. Integrating the shock severity and CS phenotype with nonmodifiable risk factors for mortality can guide clinical decision-making and prognostication. Identifying and treating the cause of CS is crucial for success, including early culprit vessel revascularization for AMI. Vasopressors and inotropes titrated to restore arterial pressure and perfusion are the cornerstone of initial medical therapy for CS. Temporary mechanical circulatory support (MCS) is indicated for appropriately selected patients as a bridge to recovery, decision, durable MCS, or heart transplant. Randomized controlled trials have not demonstrated better survival with the routine use of temporary MCS in patients with CS. Accordingly, a multidisciplinary team-based approach should be used to tailor the type of hemodynamic support to each individual CS patient's needs based on shock severity, phenotype, and exit strategy.}},
  author       = {{Jentzer, Jacob C. and Pöss, Janine and SCHAUBROECK, HANNAH and Morrow, David A. and Hollenberg, Steven M. and Mebazaa, Alexandre}},
  issn         = {{0090-3493}},
  journal      = {{CRITICAL CARE MEDICINE}},
  keywords     = {{Critical Care and Intensive Care Medicine,shock,mechanical circulatory support,heart failure,cardiogenic shock,acute myocardial infarction}},
  language     = {{eng}},
  number       = {{9}},
  pages        = {{1222--1233}},
  publisher    = {{Ovid Technologies (Wolters Kluwer Health)}},
  title        = {{Advances in the management of cardiogenic shock}},
  url          = {{http://doi.org/10.1097/ccm.0000000000005919}},
  volume       = {{51}},
  year         = {{2023}},
}
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