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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.