What is cardiogenic shock (CS)?

Cardiogenic shock (CS) is a life-threatening condition, caused by inadequate tissue perfusion due to cardiac dysfunction. Or in simple terms: the heart suddenly is incapable to pump enough blood to meet the body’s needs.

CS evolves to refractory CS when it persists despite volume administration, inotropes, vasoconstrictors and mild forms of mechanical circulatory support, like intra-aortic balloon pump (IABP). Acute myocardial infarction (AMI) – popularly known as “heart attack” – is one of the most common clinical conditions leading to CS.[1]

Some facts about cardiogenic shock:

  • CS complicates AMI in 5 to 15% of patients. It is the leading cause of death in AMI patients (~50% mortality) which account for ~40,000 – 50,000 patients in Europe and 60,000 – 70,000 patients in the USA annually.[2]
  • Medical therapy using inotropic agents and vasopressors is often ineffective for adequate hemodynamic support.[1]

ECMO’s primary scope in cardiogenic shock is circulatory support. Secondarily, it can also provide gas exchange – remembering that an oxygenator is always part of any ECMO circuit. Usually, a veno-arterial cannulation is used. Unlike veno-venous cannulation, the return cannula has to be placed in the arterial vessels system in order to replace the failing heart function.[3]

References:

[1] Briceno, N. et al. (2016). Percutaneous mechanical circulatory support: current concepts and future directions. Heart, 102(18), 1494-1507

[2] Thiele, H. et al. (2015). Management of cardiogenic shock. Eur Heart J, 36(20), 1223–1230

[3] Napp, L. C. et al. (2017). ECMO in cardiac arrest and cardiogenic shock. Herz, 42(1), 27-44