Cardiogenic Shock (contractility) Flashcards
Discuss the role of IABP and LVAD in the management of cardiogenic shock. Discuss short-term and long-term considerations of placing a patient on a ventricular assist device.
IABP is used as a supportive treatment tool in a clinical context that will improve (bridging therapy)
due to recovery or treatment cardiogenic shock, post bypass, post MI, cardiomyopathy, severe IHD awaiting surgery or stenting, severe acute MR awaiting surgery, prophylactically in high risk patient pre-stenting/ cardiac surgery
Intra-Aortic Balloon Pumps have also been inserted as a last-ditch measure to stop haemorrhage from the aorta or its branches (e.g. massive Gl haemorrhage)
IABP-SHOCK II trial (2012)
showed no 30-day mortality benefit from IABP insertion for cardiogenic shock following MI when early revascularisation was planned.
LVAD can also improve secondary organ function prior to transplantation, reduce pulmonary hypertension, and enable improvement in nutritional status, all of which are associated with improved post-transplant survival.
Nowadays, 80-85 per cent of patients are alive a year after having an LVAD fitted and 70-75 per cent after two years. Patients who have been too unwell to walk around are quickly able to get up and about.
Many patients can soon return to other normal activities like driving and going on holiday; some of them even return to work.
Nearly one-third of patients die or have a persistently poor quality of life over the year after LVAD. integrating
Discuss resuscitation goals in a cardiogenic shock patient with a
“normal” BP but evidence of end organ ischemia.
The primary goals of resuscitation in a cardiogenic shock patient with a “normal” blood pressure but evidence of end organ ischemia are to improve cardiac output and oxygen delivery to the organs, restore tissue perfusion, and improve organ function.
This can be accomplished by addressing the underlying cause of the shock, optimizing preload, afterload, and contractility, and providing appropriate inotropic and vasopressor support.
It is important to take steps to improve preload, such as using diuretics to reduce pulmonary edema and/or increasing fluid administration if the patient is hypotensive.
Afterload can be reduced with vasodilators such as nitroprusside, while contractility can be improved with inotropes such as dopamine or dobutamine.
Additionally, mechanical support such as intra-aortic balloon pump or mechanical circulatory support devices can be used to augment cardiac output and help to restore organ perfusion. It is also important to provide supportive care such as oxygen supplementation, ventilatory support, and management of electrolyte and acid-base abnormalities.
