Does Early Mechanical Circulatory Support Improve Cardiogenic Shock Outcomes?

Authors

Joseph Miessau, University of LynchburgFollow

Specialty

Cardiothoracic Surgery

Advisor

Dr. Witte

Abstract

ABSTRACT

Introduction: Cardiogenic shock (CS) is the most common cause of mortality following acute myocardial infarction (AMI).CS is a significant cause of in-hospital mortality, with rates ranging from 50-80% when treated conservatively. Pharmacologic management for CS is ineffective at decreasing mortality. It is suggested that early mechanical circulatory support (MCS) reduces mortality and morbidity in CS. Initiatives put forth by healthcare systems look to minimize hospital stay length, reduce complications, and improve the quality of care for patients with cardiogenic shock. In recent years there has been interest in developing multidisciplinary "shock teams" to reduce time to support and enhance CS outcomes.

Methods: A PubMed advanced search for full text for systematic reviews, randomized control trials, and meta-analysis completed. After a careful appraisal, twenty-two peer review articles were evaluated and appropriately supported this article's topic.

Results: Early implementation of mechanical circulatory support (MCS) devices has been shown to improve CS outcomes after AMI, inotrope refractory CS, and subsequent chronic systolic heart failure. Evidence suggests the early implementation of MCS in CS associated with AMI reduces mortality.

Conclusion: CS has a high mortality rate, which is still unacceptable despite advances in MCS. Initiation of MCS earlier to the onset of CS before end-organ dysfunction may be effective at reducing mortality. The recommended primary goal of therapy is to reduce left ventricular unloading, reduce lactic acid production, and reverse end-organ ischemia. The trend of creating a multidisciplinary CS initiative or "shock team" is apparent and encouraged to improve outcomes from CS. Determination of percutaneous versus surgical MCS calls for a multidisciplinary approach to management.

Recommended Citation

Miessau J. Does Early Mechanical Circulatory Support Improve Cardiogenic Shock Outcomes?. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2021; 3(3).