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Update in intensive care medicine: Cardiogenic shock
Available online 11 October 2024
Mechanical circulatory support in cardiogenic shock patients
Soporte circulatorio mecánico en el paciente en shock cardiogénico
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Luis Martin-Villena,
Corresponding author
, Alejandro Adsuar-Gomezb, Jose Manuel Garrido-Jimenezc, Jose Luis Perez-Velad, Mari Paz Fuset-Cabanese
a Department of Intensive Care Medicine, Hospital Universitario Virgen del Rocío, Seville, Spain
b Department of Cardiovascular Surgery, Hospital Universitario Virgen del Rocío, Seville, Spain
c Department of Cardiovascular Surgery, Hospital Universitario Virgen de las Nieves, Granada, Spain
d Department of Intensive Care Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
e Department of Intensive Care Medicine, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
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Tables (3)
Table 1. Characteristics of the main mechanical circulatory support devices.
Table 2. Causes of cardiogenic shock amenable to mechanical circulatory support.
Table 3. Contraindications of mechanical circulatory support.
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Additional material (1)
Abstract

Cardiogenic shock (CS) is a highly complex clinical condition that requires a management strategy focused on early resolution of the underlying cause and the provision of circulatory support. In cases of refractory CS, mechanical circulatory support (MCS) is employed to replace the failed cardiocirculatory system, thereby preventing the development of multiorgan failure. There are various types of MCS, and patients with CS typically require devices that are either short-term (< 15 days) or intermediate-term (15–30 days). When choosing the device the underlying cause of CS, as well as the presence or absence of concomitant conditions such as failed ventricle, respiratory failure, and the intended purpose of the support should be taken into consideration. Patients with MCS require the comprehensive care indicated in complex critically ill patients with multiorgan dysfunction, with an emphasis on device monitoring and control. Different complications may arise during support management, and its withdrawal must be protocolized.

Keywords:
Shock
Cardiogenic
Mechanical circulatory support
ECMO
Ventricular device
Resumen

El shock cardiogénico (SC) es un cuadro clínico de alta complejidad que requiere un manejo centrado en resolver de forma precoz la causa condicionante y asegurar un soporte circulatorio. En caso de shock refractario, los sistemas de soporte circulatorio mecánico (SCM) permiten suplir al sistema cardiocirculatorio fracasado para evitar el desarrollo de fracaso multiorgánico. Existen diferentes tipos de SCM y en los pacientes en SC se suelen contemplar dispositivos de corta (menos de 15 días) o intermedia duración (15–30 días). Para su elección se debe tener en cuenta la causa que ha condicionado el SC y aspectos como el ventrículo fracasado, la presencia/ausencia de insuficiencia respiratoria y el propósito del soporte. Los pacientes con SCM requieren un cuidado integral de enfermo crítico complejo con disfunción multiorgánica, haciendo hincapié en la monitorización y el control del dispositivo. Durante su manejo puede aparecer diferentes complicaciones y su retirada debe estar protocolizada.

Palabras clave:
Shock
Cardiogénico
Soporte circulatorio mecánico
ECMO
Dispositivo ventricular

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