Cardiogenic shock.

Susanna Price, Jacob C Jentzer, David A Morrow, Marianna Adamo, Daniel Brodie, Alain Combes, Holger Thiele, Roberto Lorusso, Alexandre Mebazaa, Enzo Lüsebrink, Leonhard Binzenhöfer

Journal: Lancet (London, England) 2024;404(10466):2006-2020

PMID: 39550175

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Abstract

Cardiogenic shock is a complex syndrome defined by systemic hypoperfusion and inadequate cardiac output arising from a wide array of underlying causes. Although the understanding of cardiogenic shock epidemiology, specific subphenotypes, haemodynamics, and cardiogenic shock severity staging has evolved, few therapeutic interventions have shown survival benefit. Results from seminal randomised controlled trials support early revascularisation of the culprit vessel in infarct-related cardiogenic shock and provide evidence of improved survival with the use of temporary circulatory support in selected patients. However, numerous questions remain unanswered, including optimal pharmacotherapy regimens, the role of mechanical circulatory support devices, management of secondary organ dysfunction, and best supportive care. This Review summarises current definitions, pathophysiological principles, and management approaches in cardiogenic shock, and highlights key knowledge gaps to advance individualised shock therapy and the evidence-based ethical use of modern technology and resources in cardiogenic shock.

Address: Department of Medicine I, LMU University Hospital, Munich, Germany.; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy; Department of Cardiology, ASST Spedali Civili, Brescia, Italy.; Cardio-Thoracic Surgery Department, Maastricht University Medical Centre, Maastricht, Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, Netherlands.; Université Paris Cité, Unité MASCOT Inserm, APHP Hôpitaux Saint Louis and Lariboisière, Paris, France.; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA.; Cardiology and Critical Care, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College, London, UK.; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.; Department of Medicine, Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.; Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France; Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, Paris, France.; Leipzig Heart Science, Leipzig, Germany; Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany. Electronic address: [email protected].

DOI: 10.1016/S0140-6736(24)01818-X

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MeSH Terms: Shock, Cardiogenic, Humans, Heart-Assist Devices, Myocardial Infarction, Hemodynamics