Published in:
20-12-2023 | Cardiogenic Shock | Goal-Directed Therapy (M Legrand, Section Editor)
Goal-Directed Therapy in Cardiogenic Shock: No Magical Recipe
Published in: Current Anesthesiology Reports | Issue 1/2024
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Purpose of Review
Cardiogenic shock (CS) remains a critical condition associated with a high mortality rate. Early and appropriate management may prevent or reverse multiple organ failure. Various strategies have been proposed to appropriately manage CS, but no goal-directed therapy has yet been validated.
Recent Findings
In this narrative review, we propose a physiological-based goal-directed therapy that relies on both flow and pressure monitoring to adapt the titration of inotropic and vasopressor drugs. Along with addressing the initial trigger, these physiological endpoints should serve as the benchmark for accurately adjusting therapeutics up to veno-arterial extracorporeal membrane oxygenation implementation if necessary.
Summary
The ultimate challenge is to define early in the trajectory of patients with cardiogenic shock, whether it is a bridge to recovery or, if eligible, a bridge to heart transplantation or a long-term assistance device.
Graphical Abstract
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MAP, mean arterial pressure; RAP, right atrial pressure; RV, right ventricle; mPAP, mean pulmonary artery pressures; PCWP, pulmonary capillary wedge pressures; HTx, heart transplantation; TTE, transthoracic echocardiography; LVOT VTI, left ventricular outflow tract velocity time integral; IVC, inferior vena cava; LVFP, left ventricular filling pressures; CS, cardiogenic shock; CO, cardiac output; PAC, pulmonary artery catheter; PICCO, pulse index continuous cardiac output; CRT, capillary refill time.