Pearls for the Patient in Cardiogenic Shock

• Cardiogenic shock is generally defined as tissue hypoperfusion due to ineffective cardiac output.
• Despite therapeutic advances, 30-day mortality for cardiogenic shock can reach 50%.
• Though there are several different phenotypes and severity of staging, consider the following pearls in the initial resuscitation of patients with cardiogenic shock:
  • Early arterial line placement for accurate blood pressure monitoring.
  • Supplemental oxygen to maintain O2 > 90%.
  • NIPPV to reduce the work of breathing for patients with pulmonary edema.
  • Use of lung-protective ventilation for patients who require intubation and mechanical ventilation.
  • Vasopressor and inotrope therapy for hemodynamic support.
    • Norepinephrine is the preferred first-line vasopressor. 
    • Dobutamine or milrinone for inotrope support.
  • Early revascularization for patients with cardiogenic shock due to acute MI.

References

Jentzer JC, et al. Advances in the management of cardiogenic shock. Crit Care Med. 2023; 51:1222-1233.