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Cardiogenic Shock

Cardiogenic Shock

1. Persistent hypotension 
    - (SBP <90 mmHg or MAP below baseline)
2. Cardiac Index <1.8 L/min/m^2 w/o support 
    - (<2.2 L/min/m^2 with support)
3. Adequate or elevated filling pressure 
    - (LVEDP >18 mmHg, RVEDP >10 mmHg) 


  • Ischemic
  • Valve related
    • Acute Aortic or Mitral Regurgitation
  • Rate Related
  • Cardiomyopathy
  • Toxicologic


Mechanical Cardiac Support (MCS)

  • Indications for MCS
    • Cardiogenic shock due to
      • Acute myocardial infarction and related mechanical complications
      • Acute decompensated heart failure
      • Acute myocarditis
      • Post-cardiotomy shock
      • Acute rejection post-cardiac transplant with hemodynamic compromise
    • High-risk interventions
      • Percutaneous coronary intervention
      • Ventricular tachycardia ablation
    • Bridge to LVAD or transplant
    • Right ventricular failure

Differences in MCS

  • Impella
    • Decreases PCWP
    • Increases coronary blood flow, reduces infarct size
    • Works independently of LV function and cardiac rhythm
    • Impella 2.5
      • CO: 2.5-4 L/min
    • Impella 5
      • CO: 5 L/min
      • Requires surgical cutdown
    • Notes
      • Wean to P2, pull from LV on P2, change to P0 and remove
      • Set to P2 to adjust

Courtesy of Ouweneel, D. M., Claessen, B. E., Sjauw, K. D., & Henriques, J. P. (2015). The Role of Percutaneous Haemodynamic Support in High-risk Percutaneous Coronary Intervention and Cardiogenic Shock. Interventional cardiology (London, England), 10(1), 39–44.


Illustration of Ventricular Assist Devices. Courtesy of Abdul-Rahman T, Lizano-Jubert I, Garg N, Tejerina-Marion E, Awais Bukhari SM, Luisa Ek A, Wireko AA, Mares AC, Sikora V, Gupta R. The Use of Cardioprotective Devices and Strategies in Patients Undergoing Percutaneous Procedures and Cardiac Surgery. Healthcare (Basel). 2023 Apr 11;11(8):1094. doi: 10.3390/healthcare11081094. PMID: 37107928; PMCID: PMC10137626.