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      The medical treatment of cardiogenic shock

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          Abstract

          Cardiogenic shock (CS) is a leading cause of mortality worldwide. CS presentation and management in the current era have been widely depicted in epidemiological studies. Its treatment is codified and relies on medical care and extracorporeal life support (ECLS) in the bridge to recovery, chronic mechanical device therapy, or transplantation. Recent improvements have changed the landscape of CS. The present analysis aims to review current medical treatments of CS in light of recent literature, including addressing excitation–contraction coupling and specific physiology on applied hemodynamics. Inotropism, vasopressor use, and immunomodulation are discussed as pre-clinical and clinical studies have focused on new therapeutic options to improve patient outcomes. Certain underlying conditions of CS, such as hypertrophic or Takotsubo cardiomyopathy, warrant specifically tailored management that will be overviewed in this review.

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          Most cited references90

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          2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure

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            2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC).

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              Intraaortic balloon support for myocardial infarction with cardiogenic shock.

              In current international guidelines, intraaortic balloon counterpulsation is considered to be a class I treatment for cardiogenic shock complicating acute myocardial infarction. However, evidence is based mainly on registry data, and there is a paucity of randomized clinical trials. In this randomized, prospective, open-label, multicenter trial, we randomly assigned 600 patients with cardiogenic shock complicating acute myocardial infarction to intraaortic balloon counterpulsation (IABP group, 301 patients) or no intraaortic balloon counterpulsation (control group, 299 patients). All patients were expected to undergo early revascularization (by means of percutaneous coronary intervention or bypass surgery) and to receive the best available medical therapy. The primary efficacy end point was 30-day all-cause mortality. Safety assessments included major bleeding, peripheral ischemic complications, sepsis, and stroke. A total of 300 patients in the IABP group and 298 in the control group were included in the analysis of the primary end point. At 30 days, 119 patients in the IABP group (39.7%) and 123 patients in the control group (41.3%) had died (relative risk with IABP, 0.96; 95% confidence interval, 0.79 to 1.17; P=0.69). There were no significant differences in secondary end points or in process-of-care measures, including the time to hemodynamic stabilization, the length of stay in the intensive care unit, serum lactate levels, the dose and duration of catecholamine therapy, and renal function. The IABP group and the control group did not differ significantly with respect to the rates of major bleeding (3.3% and 4.4%, respectively; P=0.51), peripheral ischemic complications (4.3% and 3.4%, P=0.53), sepsis (15.7% and 20.5%, P=0.15), and stroke (0.7% and 1.7%, P=0.28). The use of intraaortic balloon counterpulsation did not significantly reduce 30-day mortality in patients with cardiogenic shock complicating acute myocardial infarction for whom an early revascularization strategy was planned. (Funded by the German Research Foundation and others; IABP-SHOCK II ClinicalTrials.gov number, NCT00491036.).
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                Author and article information

                Contributors
                Journal
                J Intensive Med
                J Intensive Med
                Journal of Intensive Medicine
                Elsevier
                2667-100X
                19 January 2023
                30 April 2023
                19 January 2023
                : 3
                : 2
                : 114-123
                Affiliations
                [1 ]Service de Médecine Intensive et Réanimation Brabois, CHRU Nancy, Pôle Cardio-Médico-Chirurgical, Vandoeuvre-les-Nancy 54511, France
                [2 ]INSERM U1116, Faculté de Médecine, Vandoeuvre-les-Nancy 54511, France
                [3 ]Université de Lorraine, Vandoeuvre-les-Nancy 54000, France
                Author notes
                [* ]Corresponding author: Bruno Levy, Medical Intensive Care Unit, University Hospital of Nancy, Brabois, Rue du Morvan, Vandoeuvre-Lès-Nancy 54500, France. blevy5463@ 123456gmail.com
                Article
                S2667-100X(22)00121-9
                10.1016/j.jointm.2022.12.001
                10175741
                fe43ff74-36a3-4e44-aa0e-7b17028aea06
                © 2022 The Author(s)

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 19 September 2022
                : 21 November 2022
                : 4 December 2022
                Categories
                Review

                cardiogenic shock,etiology,epidemiology,medical treatment,monitoring

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