A Critical Review of Hemodynamically Guided Therapy for Cardiogenic Shock: Old Habits Die Hard

Abstract

Purpose of review Here, we review the importance of using hemodynamic data to guide therapy and risk stratification in cardiogenic shock as well as the various definitions of this syndrome that have been used in prior studies. Furthermore, we provide perspective regarding the controversy surrounding pulmonary artery (PA) catheter use as well as current society guidelines and scientific statements. Lastly, we review the technical aspects for accurate interpretation of data of cardiogenic shock. Recent findings More recent studies specifically evaluating cardiogenic shock patients have shown higher mortality when PA catheters were not used. Furthermore, initiatives are underway to develop more standardized definitions of cardiogenic shock, including the SCAI Shock Classification Scheme. Only by having a standardized fashion of conveying severity of shock will we be able to more systematically study this patient population and improve outcomes moving forward. Summary PA catheters are critical to the prognostication and management of a subset of patients with cardiopulmonary disease, particularly in those with pulmonary hypertension, cardiogenic shock, or requiring mechanical circulatory support or undergoing evaluation for advanced heart failure therapies.

Application Value of Emergency Bedside Echocardiography in Early Warning of Acute and Severe Shock and Clinical Classification

“…The existing examination methods mainly rely on monitoring blood pressure, heart rate, cardiac index, CVP, pulmonary artery wedge pressure (PAWP), and other hemodynamic tests to diagnose shock [ 2 ]. For example, the important marker of decompensation stage of shock is the decrease of CVP.…”

Supportive care of right ventricular failure due to fat embolism syndrome

“…8–12 mmHg) has been suggested by some experts [ 10 , 11 ]. This is one population where continuous monitoring of hemodynamics via use of pulmonary artery catheter may be beneficial, although caution should be used as CVP may not always be a reliable indicator of fluid responsiveness in RV failure [ 12 , 13 ]. Given this delicate balance of preload, early consideration should be given to initiate pressors [ 9 ].…”

Declaración de consenso internacional y multidisciplinario del Colegio Mexicano de Cardiología Intervencionista y Terapia Endovascular (COMECITE) sobre la monitorización invasiva de la arteria pulmonar

“…INTRODUCTION I t has been more than fifty years since the Swan-Ganz (SG) catheter was first used for invasive hemodynamic monitoring and there has been ongoing controversy regarding benefits and risks of its use. [1][2][3][4] The Mexican College of Interventional Cardiology and Endovascular Therapy (COMECITE: Colegio Mexicano de Cardiología Intervencionista y Terapia Endovascular) invited a select group of international specialists in interventional cardiology, critical cardiology care, and general intensive care, to discuss the current use of invasive pulmonary artery monitoring, its benefit/risk and to publish a consensus statement on SG catheter use, endorsed by COMECITE, the Mexican College of Critical Care (COMMEC: Colegio Mexicano de Medicina Crítica) through its cardiovascular care working group, plus other invited medical organizations.…”

“…3 Mexican College of Interventional Cardiology and Endovascular Therapy (COMECITE: Colegio Mexicano de Cardiología Intervencionista y Terapia Endovascular). 4 Clínica de Estudios Médicos. Guadalajara, México.…”