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Management of cardiogenic shock : state-of-the-art

Jung, Christian ; Bruno, Raphael Romano ; Jumean, Marwan ; Price, Susanna ; Krychtiuk, Konstantin A. ; Ramanathan, Kollengode ; Dankiewicz, Josef LU orcid ; French, John ; Delmas, Clement and Mendoza, Alexandra Arias , et al. (2024) In Intensive Care Medicine 50(11). p.1814-1829
Abstract

The management of cardiogenic shock is an ongoing challenge. Despite all efforts and tremendous use of resources, mortality remains high. Whilst reversing the underlying cause, restoring/maintaining organ perfusion and function are cornerstones of management. The presence of comorbidities and preexisting organ dysfunction increases management complexity, aiming to integrate the needs of vital organs in each individual patient. This review provides a comprehensive overview of contemporary literature regarding the definition and classification of cardiogenic shock, its pathophysiology, diagnosis, laboratory evaluation, and monitoring. Further, we distill the latest evidence in pharmacologic therapy and the use of mechanical circulatory... (More)

The management of cardiogenic shock is an ongoing challenge. Despite all efforts and tremendous use of resources, mortality remains high. Whilst reversing the underlying cause, restoring/maintaining organ perfusion and function are cornerstones of management. The presence of comorbidities and preexisting organ dysfunction increases management complexity, aiming to integrate the needs of vital organs in each individual patient. This review provides a comprehensive overview of contemporary literature regarding the definition and classification of cardiogenic shock, its pathophysiology, diagnosis, laboratory evaluation, and monitoring. Further, we distill the latest evidence in pharmacologic therapy and the use of mechanical circulatory support including recently published randomized-controlled trials as well as future directions of research, integrating this within an international group of authors to provide a global perspective. Finally, we explore the need for individualization, especially in the face of neutral randomized trials which may be related to a dilution of a potential benefit of an intervention (i.e., average effect) in this heterogeneous clinical syndrome, including the use of novel biomarkers, artificial intelligence, and machine learning approaches to identify specific endotypes of cardiogenic shock (i.e., subclasses with distinct underlying biological/molecular mechanisms) to support a more personalized medicine beyond the syndromic approach of cardiogenic shock.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Assist device, Cardiogenic shock, Heart failure, Intensive care, Myocardial infarction, Outcome
in
Intensive Care Medicine
volume
50
issue
11
pages
16 pages
publisher
Springer Science and Business Media B.V.
external identifiers
  • scopus:85203449361
  • pmid:39254735
ISSN
0342-4642
DOI
10.1007/s00134-024-07618-x
language
English
LU publication?
yes
additional info
Publisher Copyright: © The Author(s) 2024.
id
ecac3092-7363-41fa-847c-250a27f31209
date added to LUP
2024-12-04 10:02:42
date last changed
2025-07-17 04:29:26
@article{ecac3092-7363-41fa-847c-250a27f31209,
  abstract     = {{<p>The management of cardiogenic shock is an ongoing challenge. Despite all efforts and tremendous use of resources, mortality remains high. Whilst reversing the underlying cause, restoring/maintaining organ perfusion and function are cornerstones of management. The presence of comorbidities and preexisting organ dysfunction increases management complexity, aiming to integrate the needs of vital organs in each individual patient. This review provides a comprehensive overview of contemporary literature regarding the definition and classification of cardiogenic shock, its pathophysiology, diagnosis, laboratory evaluation, and monitoring. Further, we distill the latest evidence in pharmacologic therapy and the use of mechanical circulatory support including recently published randomized-controlled trials as well as future directions of research, integrating this within an international group of authors to provide a global perspective. Finally, we explore the need for individualization, especially in the face of neutral randomized trials which may be related to a dilution of a potential benefit of an intervention (i.e., average effect) in this heterogeneous clinical syndrome, including the use of novel biomarkers, artificial intelligence, and machine learning approaches to identify specific endotypes of cardiogenic shock (i.e., subclasses with distinct underlying biological/molecular mechanisms) to support a more personalized medicine beyond the syndromic approach of cardiogenic shock.</p>}},
  author       = {{Jung, Christian and Bruno, Raphael Romano and Jumean, Marwan and Price, Susanna and Krychtiuk, Konstantin A. and Ramanathan, Kollengode and Dankiewicz, Josef and French, John and Delmas, Clement and Mendoza, Alexandra Arias and Thiele, Holger and Soussi, Sabri}},
  issn         = {{0342-4642}},
  keywords     = {{Assist device; Cardiogenic shock; Heart failure; Intensive care; Myocardial infarction; Outcome}},
  language     = {{eng}},
  number       = {{11}},
  pages        = {{1814--1829}},
  publisher    = {{Springer Science and Business Media B.V.}},
  series       = {{Intensive Care Medicine}},
  title        = {{Management of cardiogenic shock : state-of-the-art}},
  url          = {{http://dx.doi.org/10.1007/s00134-024-07618-x}},
  doi          = {{10.1007/s00134-024-07618-x}},
  volume       = {{50}},
  year         = {{2024}},
}