Ischaemic cardiogenic shock

The recognition of cardiogenic shock in the setting of myocardial ischaemia has important prognostic and therapeutic implications. Resuscitative efforts should focus on stabilizing circulatory and respiratory function, with early restoration of coronary blood flow to avoid multi-organ dysfunction and death. The associated mortality rate remains high, in the order of 40–50%, and few therapeutic strategies have proven to reduce short- and long-term morbidity and mortality to date. This article highlights several key recent advances in the management of ischaemic cardiogenic shock, including the use of early bedside echocardiography to confirm the diagnosis, and culprit only lesion strategy of early revascularization. Furthermore, we appraise the variety of mechanical cardiac supports (MCS) that are increasingly being used to assist the management of ischaemic cardiogenic shock in those cases refractory to pharmacological intervention. To date the optimal timing for deployment, mode superiority and the mortality benefit associated with MCS is yet to be established and we await the results of prospective trials to firmly establish the role in the management of cardiogenic shock.