UPDATES ON CARDIOGENIC SHOCK: DIAGNOSIS AND MANAGEMENT

Received 2022-04-02; Accepted 2023-04-09; Published 2023-06-07

Abstract

Cardiogenic shock (CS) is a complex condition causing end-organ hypoperfusion and high mortality rates especially in patients with acute myocardial infarction. It remains a challenge for clinician to provide good outcomes despite the development of evidence-based therapeutic strategies, especially for interventional management. Although there has been an improvement in survival, the mortality remains high. There are still many uncertainties regarding the best treatment, as clinicians need to weigh the risks and benefits. This review aims to elaborate the latest updates in the field of CS. To enhance contractility and systemic vascular resistance and hence avoid organ damage, inotropic and vasopressin agents are often administered in the therapy of CS. Despite their usefulness and widespread use, administration of these medicines requires close monitoring and the lowest effective dosage administered in the shortest amount of time possible to prevent adverse effects including increased oxygen demand, arrhythmia, and impaired microcirculation of the tissue. When pharmacological agents fail to provide an adequate response, mechanical circulatory support (MCS) devices like the intraaortic balloon pump (IABP), left ventricular assist devices (LVAD), venoarterial extracorporeal membrane oxygenation (VA-ECMO), and revascularization become an option to provide haemodynamic support.