Management of cardiogenic shock: state-of-the-art.

Autor: Jung C; Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Medical Faculty, Duesseldorf, Germany. Christian.jung@med.uni-duesseldorf.de.; Cardiovascular Research Institute Düsseldorf (CARID), Düsseldorf, Germany, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany. Christian.jung@med.uni-duesseldorf.de., Bruno RR; Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Medical Faculty, Duesseldorf, Germany., Jumean M; UTHealth McGovern Medical School, Houston, TX, USA., Price S; Division of Heart, Lung and Critical Care, Royal Brompton Hospital, London, UK.; National Heart and Lung Institute, Imperial College London, London, UK., Krychtiuk KA; Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria., Ramanathan K; Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore.; Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore, Singapore., Dankiewicz J; Department of Clinical Sciences Lund, Lund University, Cardiology, Lund, Sweden., French J; Department of Cardiology, Liverpool Hospital, Sydney, Australia.; School of Medicine, Western Sydney University, Sydney, Australia.; South Western Sydney Clinical School, The University of New South Wales, Sydney, Australia., Delmas C; Intensive Cardiac Care Unit, Cardiology Department, Toulouse University Hospital, Institute of Metabolic and Cardiovascular Diseases (I2MC), UMR-1048, National Institute of Health and Medical Research (INSERM), Toulouse, France.; REICATRA, Institut Saint Jacques, CHU de Toulouse, Toulouse, France., Mendoza AA; Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico., Thiele H; Department of Internal Medicine/Cardiology and Leipzig Heart Science, Heart Center Leipzig at University of Leipzig, Leipzig, Germany., Soussi S; Department of Anesthesia and Pain Management, University Health Network (UHN), Women's College Hospital, University of Toronto, Toronto Western Hospital, Toronto, Canada.; University of Paris Cité, Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Paris, France.
Jazyk: angličtina
Zdroj: Intensive care medicine [Intensive Care Med] 2024 Nov; Vol. 50 (11), pp. 1814-1829. Date of Electronic Publication: 2024 Sep 10.
DOI: 10.1007/s00134-024-07618-x
Abstrakt: The management of cardiogenic shock is an ongoing challenge. Despite all efforts and tremendous use of resources, mortality remains high. Whilst reversing the underlying cause, restoring/maintaining organ perfusion and function are cornerstones of management. The presence of comorbidities and preexisting organ dysfunction increases management complexity, aiming to integrate the needs of vital organs in each individual patient. This review provides a comprehensive overview of contemporary literature regarding the definition and classification of cardiogenic shock, its pathophysiology, diagnosis, laboratory evaluation, and monitoring. Further, we distill the latest evidence in pharmacologic therapy and the use of mechanical circulatory support including recently published randomized-controlled trials as well as future directions of research, integrating this within an international group of authors to provide a global perspective. Finally, we explore the need for individualization, especially in the face of neutral randomized trials which may be related to a dilution of a potential benefit of an intervention (i.e., average effect) in this heterogeneous clinical syndrome, including the use of novel biomarkers, artificial intelligence, and machine learning approaches to identify specific endotypes of cardiogenic shock (i.e., subclasses with distinct underlying biological/molecular mechanisms) to support a more personalized medicine beyond the syndromic approach of cardiogenic shock.
(© 2024. The Author(s).)
Databáze: MEDLINE
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