Cardiogenic Shock

Cardiogenic Shock¶

1. Persistent hypotension (SBP <90 mmHg or MAP mmHg below baseline)
2. Cardiac Index <1.8 L/min/m^2 without support (<2.2 L/min/m^2 with support)
3. Adequate or elevated filling pressure (LVEDP >18 mmHg, RVEDP >10 mmHg) 

Management¶

• Contemporary Management
• Figure out etiology
  • Valve related
  • Ischemic
    • Impella in STEMI
  • Rate Related
  • Cardiomyopathy
  • Toxicologic
• Start Inotropes
  • Milrinone = Dobutamine
  • Pressors if needed for MAP > 65
    • Levophed > Dopamine
    • Epinephrine is good too
• Shock Centers

Mechanical Support¶

• Great EMCrit article
• Journal Feed