Cardiogenic Shock: Therapy

General measures

  • Immediately make an emergency call! (Call number 112)
  • Symptom-oriented positioning of the patient:
    • Dyspnea (shortness of breath): elevate upper body (semi-sitting).
    • Circulatory dysregulation (hypovolemia: decrease in circulating blood volume): flat positioning with legs elevated (Trendelenburg positioning).
    • Clouding of consciousness: stable lateral position (to keep the airways free: fall back of the tongue and possible vomiting to prevent).
  • Placement of venous access (min 18 G) to treat impending hypovolemia (decrease in circulating blood volume): In case of anaphylaxis:
    • Adults: 5-10 min briskly 500-1,000 ml of fluid (more if necessary).
    • Children: 20 ml/kg bw
  • Securing the airway (endotracheal intubation/insertion of a tube (hollow probe) through the mouth or nose between the vocal folds of the larynx into the trachea).

Conventional non-surgical therapy methods

  • Percutaneous coronary intervention or percutaneous coronary intervention (abbreviation PCI; synonym: percutaneous transluminal coronary angioplasty, PTCA; percutaneous transluminal coronary angioplasty); indication: infarct-related cardiogenic shock; note: earliest possible revascularization of the occluded/stenosed coronary vessel (“culprit lesion”) – and usually by means of primary PCI (pPCI).
    • For revascularization of infarct-related cardiogenic shock (ICS), intracoronary stenting using drug-eluting stents (DES) should be preferred.
    • IABP (intra-aortic balloon pump) should not be implanted for IkS due to pump failure during primary PCI [iks-LL 2018].
    • “In the patient with coronary multivessel disease and multiple relevant stenoses (>70%), only the infarct-causing lesion (“culprit lesion”) should be treated during acute revascularization.” If more vessels are treated, mortality (death rate) increases.

    For more, see below the topic of the same name.

  • Electrical cardioversion for ventricular and supraventricular tachycardia.
  • Pacemaker therapy for uncontrollable bradycardia.
  • Mechanical circulatory support (mechanical active circulatory support systems (MCS)) with cardiac assist devices in refractory cardiogenic shock), percutaneous left ventricular assist devices, and extracorporeal membrane oxygenation (ECMO) can be used in the short to long term. With extracorporeal circulatory support (ECLS), both the heart and lungs can be completely replaced.