Inotropic agents and vasodilator strategies for acute myocardial infarction complicated by cardiogenic shock or low cardiac output syndrome

Unverzagt, Susanne; Wachsmuth, Lisa; Hirsch, Karin; Thiele, Holger; Buerke, Michael; Haerting, Johannes; Werdan, Karl; Prondzinsky, Roland

doi:10.1002/14651858.cd009669.pub2

Cited by 43 publications

(25 citation statements)

References 153 publications

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“…275 In this systematic review, only 1 small trial enrolling 32 patients comparing levosimendan with enoximone in refractory CS could be included. From these limited data, levosimendan may be appealing.…”

Section: Clinical Statements and Guidelinesmentioning

confidence: 99%

“…However, this agent is not approved in the United States and requires additional validation with larger studies. 275 Furthermore, the effect of other medications that have shown positive results in acute, nonshock HF populations such as seralaxin requires examination in CS cohorts. 276 Finally, as previously mentioned, percutaneous MCS devices can be useful tools for managing refractory shock.…”

Section: Clinical Statements and Guidelinesmentioning

confidence: 99%

See 1 more Smart Citation

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Diepen¹,

Katz²,

Albert³

et al. 2017

Circulation

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1,349

1,165

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Cardiogenic shock is a high-acuity, potentially complex, and hemodynamically diverse state of end-organ hypoperfusion that is frequently associated with multisystem organ failure. Despite improving survival in recent years, patient morbidity and mortality remain high, and there are few evidence-based therapeutic interventions known to clearly improve patient outcomes. This scientific statement on cardiogenic shock summarizes the epidemiology, pathophysiology, causes, and outcomes of cardiogenic shock; reviews contemporary best medical, surgical, mechanical circulatory support, and palliative care practices; advocates for the development of regionalized systems of care; and outlines future research priorities. Cardiogenic shock (CS) is a low-cardiac-output state resulting in life-threatening end-organ hypoperfusion and hypoxia.1,2 Acute myocardial infarction (MI) with left ventricular (LV) dysfunction remains the most frequent cause of CS. 1,3 Advances in reperfusion therapy have been associated with improvements in survival, but significant regional disparities in evidence-based care have been reported, and in-hospital mortality remains high (27%-51%).1,4-9 Management recommendations are distributed between disease-specific statements and guidelines, and a dedicated and comprehensive clinical resource in this area is lacking. Thus, consolidating the evidence to define contemporary best medical and surgical CS practices for both MI-associated CS and other types of CS may be an important step in knowledge translation to help attenuate disparities in evidence-based care.Regional systems of care coupled with treatment algorithms have improved survival in high-acuity time-sensitive conditions such as MI, out-of-hospital cardiac arrest (OHCA), and trauma.10-12 Applying a similar framework to CS management may lead to similar improvements in survival, and CS systems of care are emerging within existing regional cardiovascular emergency care networks; however, guidance from a national expert group on structure and systems of care has not been available. 13,14 Accordingly, the purposes of this American Heart Association (AHA) scientific statement on CS are to summarize our contemporary understanding of the epidemiology, pathophysiology, and in-hospital best care practices into a single clinical resource document; to suggest a stepwise management algorithm that integrates medical, surgical, and mechanical circulatory support (MCS) therapies; and to propose a Mission: Lifelinesupported pathway for the development of integrated regionalized CS systems of care. DEFINITION OF CSAcute cardiac hemodynamic instability may result from disorders that impair function of the myocardium, valves, conduction system, or pericardium, either in isolation HISTORICAL PERSPECTIVESBefore the routine use of early revascularization, MIassociated CS had an in-hospital mortality exceeding 80%. A registry trial of 250 patients with acute MI described the association between bedside physical examination (Killip classification) for the as...

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Section: Clinical Statements and Guidelinesmentioning

confidence: 99%

Section: Clinical Statements and Guidelinesmentioning

confidence: 99%

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Diepen¹,

Katz²,

Albert³

et al. 2017

Circulation

Self Cite

1,349

1,165

View full text Add to dashboard Cite

show abstract

“…Levosimendan induces vasodilation and improves myocardial contractility without increasing oxygen requirements and affecting blood pressure or heart rate. Compared to enoximone, levosimendan showed a borderline survival benefit in AMI complicated by cardiogenic shock or low cardiac output syndrome (hazard ratio 0.33; 95% confidence interval 0.11-0.97) and had only small differences in hemodynamics and length of hospital stay [15]. This study also showed that there was no difference between levosimendan and dobutamine in cardiogenic shock.…”

Section: Levosimendanmentioning

confidence: 55%

Medications in Cardiogenic Shock

Wang

Hung

Huang

2018

Primary Angioplasty

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“…There have been recent summaries on the use of inotropes and vasopressor agents in cardiogenic shock 39,40 , and a review of this is beyond the scope of this article. In brief, regardless of the decision to revascularise, pharmacological stabilisation of the patient in cardiogenic shock is a complex process which requires judicious use of fluids to obtain euvolaemia, vasopressors and inotropes with the aim of preventing multi-organ hypoperfusion and ultimately failure.…”

Section: (B) Pharmacological Managementmentioning

confidence: 99%

Primary Angioplasty For Patients in Cardiogenic Shock: Optimal Management

Joseph¹,

Patterson²,

Arri³

et al. 2016

Interventional Cardiology Review

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Abstract:Cardiogenic shock complicates approximately 5-10% of all myocardial infarction and remains the most common cause of death amongst these patients. Over the past few decades, the mortality associated with cardiogenic shock has improved with the introduction of early revascularization although there is limited data in patients with triple-vessel disease and left main stem disease. In more recent years, there have been a number of advances in the mechanical circulatory support devices that can help improve the haemodynamics of patients in cardiogenic shock. Despite these advances, together with progress in the use of inotropes and vasopressors, cardiogenic shock remains associated with a high morbidity and mortality. This review will outline the management of cardiogenic shock complicating acute myocardial infarction with major focus on revascularization techniques and the use of mechanical circulatory support devices.

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Inotropic agents and vasodilator strategies for acute myocardial infarction complicated by cardiogenic shock or low cardiac output syndrome

Cited by 43 publications

References 153 publications

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Medications in Cardiogenic Shock

Primary Angioplasty For Patients in Cardiogenic Shock: Optimal Management

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