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.
