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MANAGEMENT FOR CARDIOGENIC SHOCK: CLINICAL SESSION
Appropriate use of drugs is sufficient in most cases
Pierluigi Sbarra
Giovanni Bosco Hospital - Turin
Medical therapy: lack of evidence
Cochrane Database of Systematic Reviews 2014, Issue 1.
Medical therapy of Cardiogenic Shock (CS): lack of evidence
European Heart Journal (2017) 192: 200
N Engl J Med 2010; 362: 779-89
Medical therapy: first comparison…
• Observational cohorts of 1272 patients with CS, derived from 3
registries (ALARM-HF, EFICA cohort , AHEAD)
• 62% ACS (30% ADHF)
Management of CS(ADHF): Great Network
PloS One 2013; 8: e71659
PloS One 2013; 8: e71659
Management of CS(ADHF): Great Network
Management of CS in AMI: CardShock study
• Prospective study of 219 patients (8 European
coutries):
• Vasopressors (98%): Noradrenaline 75%
Dopamine 26% - Adrenaline 21%
• Inotropes (94%): Dobutamine 49% .
Levosimendan 24%
• Combination Vasopressor- Inotrope (55%)
(Noradrenaline-Dobutamine)
• 90 day Mortality: 41%
Critical Care (2016) 20: 208
Critical Care (2016) 20: 208
Management of CS in AMI: CardShock study
Critical Care (2016) 20: 208
Sodium Nitroprusside(SNP) in ADHF
JACC 2008 Vol. 52, No. 3:101
Goal-oriented Therapy in CS
G Ital Cardiol 2017;18(10):708-718
SVo2/SvcO2
SVR
MAP
VCP
No Cardiogenic shock
Fluid Challenge>200ml 15’-20’
Vasopressor( Noradrenaline)
Inotrope( Dobutamine)
Fluid Administration
< 65%-70%
Dose Reduction of Noradrenaline(low dose of Vasodilator)
Vasopressor (low dose)(No Vasodilator)
Not dose change
HCT>30% or HB>9g/dlInotrope
( Dobutamine)
Hemodynamic Target Therapy of CARDIOGENIC SHOCK
MAP< 65mmHg
Re-evaluation every 30’-60’-90’RECOVERYTreament intensification
(MSC)
European Heart Journal (2019) 40, 2671–2683
Management of CS complicating AMI without MSC
Conclusions
Vasopressors and inotropes are usually the first-line therapy at the lowest dose and short times
interval to avoid end-organ hazard
Quick multistep approach
Shock Team (Cardiac Shock Care Centers)
Rigid time-dependent protocol
Thanks!
