State of Shock: Contemporary Vasopressor and Inotrope Use in Cardiogenic Shock

Cardiogenic shock is characterized by tissue hypoxia caused by circulatory failure arising from inadequate cardiac output. In addition to treating the pathologic process causing impaired cardiac function, prompt hemodynamic support is essential to reduce the risk of developing multiorgan dysfunction...

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Bibliographic Details
Published in:Journal of the American Heart Association 2023-08, Vol.12 (15), p.e029787
Main Authors: Bloom, Jason E, Chan, William, Kaye, David M, Stub, Dion
Format: Article
Language:English
Subjects:
cardiogenic
Contemporary Review
Hemodynamics
Humans
inotrope
mechanical circulatory support
Perfusion
shock
Shock, Cardiogenic - drug therapy
Vascular Resistance
Vasoconstrictor Agents - pharmacology
Vasoconstrictor Agents - therapeutic use
vasopressor
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Summary:Cardiogenic shock is characterized by tissue hypoxia caused by circulatory failure arising from inadequate cardiac output. In addition to treating the pathologic process causing impaired cardiac function, prompt hemodynamic support is essential to reduce the risk of developing multiorgan dysfunction and to preserve cellular metabolism. Pharmacologic therapy with the use of vasopressors and inotropes is a key component of this treatment strategy, improving perfusion by increasing cardiac output, altering systemic vascular resistance, or both, while allowing time and hemodynamic stability to treat the underlying disease process implicated in the development of cardiogenic shock. Despite the use of mechanical circulatory support recently garnering significant interest, pharmacologic hemodynamic support remains a cornerstone of cardiogenic shock management, with over 90% of patients receiving at least 1 vasoactive agent. This review aims to describe the pharmacology and hemodynamic effects of current pharmacotherapies and provide a practical approach to their use, while highlighting important future research directions.
ISSN:2047-9980
2047-9980
DOI:10.1161/JAHA.123.029787