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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)

Etiology

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

Calculating CO, CI, and CPO

  • CO (Cardiac Output), L/min = VO2 / [(SaO2 - SvO2) x Hb x 13.4]
    • Where VO2 = 125 mL O2/min x BSA
    • BSA = [(Height, cm x Weight, kg)/ 3,600]½
    • In elderly patients (age ≥70 years), use 110 mL O2 x BSA for VO2
  • CI (Cardiac Index), L/min/m2 = CO/BSA
    • SV (Stroke Volume), mL/beat = CO/HR
    • Normal Values
      • CO = 4.0-8.0 L/min
      • CI = 2.5-4.0 L/min/m2
      • SV = 60-100 mL/beat
      • MAP ≥60 mmHg
    • Note: SaO2 should be acquired by arterial blood gas measurement. SvO2 should be acquired by mixed venous gas from a pulmonary artery catheter. Formula assumes decimal values, not percentages
  • CPO (Cardiac Power), W = (CO x MAP) / 451
    • CPO < 0.6 watts is indicative of hemodynamic compromise and is associated with increased risk of mortality
      • Cardiac power is the strongest hemodynamic correlate of mortality in cardiogenic shock: a report from the SHOCK trial registry
      • Improved Prognostic Performance of Cardiac Power Output With Right Atrial Pressure: A Subanalysis of the ESCAPE Trial
    • CPO Calculator

Management

Courtesy of SCAI

Further Reading