'Therapeutic Advances in the Management of Cardiogenic Shock'
Autor: | Chioncel, Ovidiu, Collins, Sean P, Ambrosy, Andrew P, Pang, Peter S, Radu, Razvan I, Ahmed, Ali, Antohi, Elena-Laura, Masip, Josep, Butler, Javed, Iliescu, Vlad Anton |
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Jazyk: | angličtina |
Rok vydání: | 2019 |
Předmět: |
medicine.medical_specialty
medicine.medical_treatment MEDLINE Shock Cardiogenic 030204 cardiovascular system & hematology Revascularization Article law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law medicine Humans Pharmacology (medical) 030212 general & internal medicine Myocardial infarction Intensive care medicine Pharmacology business.industry Cardiogenic shock General Medicine medicine.disease Triage Patient Care Management Clinical trial Heart failure business |
Popis: | Background Cardiogenic shock (CS) is a life-threatening state of tissue hypoperfusion, associated with a very high risk of mortality, despite intensive monitoring and modern treatment modalities. The present review aimed at describing the therapeutic advances in the management of CS. Areas of uncertainty Many uncertainties about CS management remain in clinical practice, and these relate to the intensity of invasive monitoring, the type and timing of vasoactive therapies, the risk-benefit ratio of mechanical circulatory support (MCS) therapy, and optimal ventilation mode. Furthermore, most of the data are obtained from CS in the setting of acute myocardial infarction (AMI), although for non-AMI-CS patients, there are very few evidences for etiological or MCS therapies. Data sources The prospective multicentric acute heart failure registries that specifically presented characteristics of patients with CS, distinct to other phenotypes, were included in the present review. Relevant clinical trials investigating therapeutic strategies in post-AMI-CS patients were added as source information. Several trials investigating vasoactive medications and meta-analysis providing information about benefits and risks of MCS devices were reviewed in this study. Therapeutic advances Early revascularization remains the most important intervention for CS in settings of AMI, and in patients with multivessel disease, recent trial data recommend revascularization on a "culprit-lesion-only" strategy. Although diverse types of MCS devices improve hemodynamics and organ perfusion in patients with CS, results from almost all randomized trials incorporating clinical end points were inconclusive. However, development of new algorithms for utilization of MCS devices and progresses in technology showed benefit in selected patients. A major advance in the management of CS is development of concept of regional CS centers based on the level of facilities and expertise. The modern systems of care with CS centers used as hubs integrated with emergency medical systems and other referee hospitals have the potential to improve patient outcomes. Conclusions Additional research is needed to establish new triage algorithms and to clarify intensity and timing of pharmacological and mechanical therapies. |
Databáze: | OpenAIRE |
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