Nonpharmacologic Management off Cardiac Arrest and Cardiogenic Shock

Goldenberg, Irvin F.

doi:10.1378/chest.102.5_supplement_2.596s

Cited by 5 publications

(1 citation statement)

References 93 publications

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“…Specific hemodynamic guidelines for mechanical circulatory support include left ventricular end-diastolic pressures >20 mmHg, left atrial pressures >25 mmHg, arterial systolic blood pressure <90 mmHg, cardiac index <1.8 1/min/m 2, and central venous pressure >20 mmHg [6]. Intraaortic balloon counterpulsation is employed alone or in combination with these agents to augment myocardial function.…”

Section: Indications For Mechanical Circulatory Supportmentioning

confidence: 99%

Status of permanent cardiac replacement for end-stage congestive heart failure

Higgins

Silverman

1996

Heart Failure Rev

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Permanent replacement of the heart in patients with end-stage congestive heart failure has long been sought after as the most definitive solution to an ever-growing problem. While cardiac transplantation is an effective therapy for many patients with end-stage congestive heart failure, this potential has been limited by the donor organ shortage and other limitations of long-term survival inherent in cardiac transplantation. While research and development of the total artificial heart continues to be of considerable interest, present-day mechanical circulatory support most commonly involves the use of left ventricular assist devices as a bridge to transplantation. Pneumatic and electromechanicai pumps are now commonly employed in modern transplant practices with excellent hemodynamic function. The TCI HeartMate left ventricular assist device is now approved by the Food and Drug Administration for clinical implantation, with excellent preliminary results. Advances in the area of temporary and extended mechanical circulatory support are crucial to the ultimate development of a totally implantable artificial heart.

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Section: Indications For Mechanical Circulatory Supportmentioning

confidence: 99%

Status of permanent cardiac replacement for end-stage congestive heart failure

Higgins

Silverman

1996

Heart Failure Rev

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Thrombolysis in acute myocardial infarction complicated by cardiogenic shock

Levine

Hochman

1995

J Thromb Thrombol

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The adverse impact of the development of cardiogenic shock in the setting of acute myocardial infarction was first described by Killip and Kimball in 1967. While the in-hospital mortality rate in patients with myocardial infarction and no evidence of heart failure was only 6%, the mortality rate in those patients who developed cardiogenic shock was 81%. Despite advances in cardiovascular care and therapy since that initial report, including universal institution of cardiac care units, advances in hemodynamic monitoring, new inotropic and vasodilating agents, and even increasing utilization of thrombolytic therapy, the mortality from acute myocardial infarction, when complicated by cardiogenic shock, remains disturbingly high, and cardiogenic shock remains the leading cause of death of hospitalized patients following acute myocardial infarction.The grave prognosis associated with this condition has resulted in increased interest in potential therapeutic interventions, particularly in the area of reperfusion therapy. Several studies suggest that, in contrast to the beneficial effects of thrombolytic therapy in most patient populations suffering acute myocardial infarction, mortality rates are not decreased in those patients with cardiogenic shock at the time of lytic administration. Thrombolytic administration does, however, appear to lead to a modest reduction in the percent of patients with myocardial infarction who will subsequently develop cardiogenic shock during hospitalization.Reperfusion rates with lytic therapy in patients with cardiogenic shock are disappointingly low, in the range of 42-48%, significantly lower than those achieved in patients without cardiogenic shock. These low perfusion rates may, in part, be explained by decreased coronary blood flow and perfusion pressure in patients with left ventricular pump failure.Although promising as adjunctive therapy, it is unclear whether institution of balloon counterpulsation has any long-term benefit in patients with cardiogenic shock treated with thrombolytic therapy. Whether other or additional interventions, such as coronary angioplasty and coronary artery bypass graft (CABG), decrease mortality rates in patients with cardiogenic shock remains to be determined.

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Cardiac Complications in the Intensive Care Unit

Francis

1999

Clinics in Chest Medicine

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Nonpharmacologic Management off Cardiac Arrest and Cardiogenic Shock

Cited by 5 publications

References 93 publications

Status of permanent cardiac replacement for end-stage congestive heart failure

Status of permanent cardiac replacement for end-stage congestive heart failure

Thrombolysis in acute myocardial infarction complicated by cardiogenic shock

Cardiac Complications in the Intensive Care Unit

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