Management of cardiogenic shock: state-of-the-art.
Christian JungRaphael Romano BrunoMarwan JumeanSusanna PriceKonstantin A KrychtiukKollengode RamanathanJosef DankiewiczJohn FrenchClement DelmasAlexandra-Arias MendozaHolger ThieleSabri SoussiPublished in: Intensive care medicine (2024)
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.
Keyphrases
- machine learning
- artificial intelligence
- randomized controlled trial
- big data
- systematic review
- stem cells
- case report
- oxidative stress
- intellectual disability
- type diabetes
- cardiovascular disease
- autism spectrum disorder
- computed tomography
- mesenchymal stem cells
- coronary artery disease
- risk assessment
- quality improvement
- current status