Update kardiogener Schock

 

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Zusammenfassung

Die IABP führt zwar zu einer linksventrikulären Entlastung, jedoch nicht zu einer Verbesserung der Mikrozirkulation und auch nicht zu einer Absenkung der Sterblichkeit.

Perkutane Unterstützungssysteme (ECLS / ECMO, pVAD) wurden bei STEMI in den letzten Jahren zunehmend häufiger implantiert, ohne dass bisher jedoch der evidenzbasierte Nachweis einer Sterblichkeitsabsenkung erbracht werden konnte.

Der PCI-Zugang über die Arteria radialis scheint beim infarktbedingten kardiogenen Schock zu einer signifikanten Absenkung der Sterblichkeit zu führen.

Ein liberales Transfusionsregime scheint bei herzchirurgischen Eingriffen mit einem verbesserten Outcome bei verminderter Häufigkeit eines kardiogenen Schocks verbunden zu sein.

Abstract

Although IABP support induces left ventricular unloading, these beneficial effect does not lead to improved microcirculation and survival. The use of percutaneous extracorporeal support systems (ECLS, ECMO) as well as left ventricular assist devices (pVAD) for adjunctive treatment of STEMI has increased during the recent years, but without sufficient evidence for a survival benefit. The PCI-access via the radial artery may lead to improved outcomes, especially in regard to survival.

A liberal transfusion regimen for red cell packages in the perioperative phase of cardiac surgery seems to improve outcomes in regard to lower incidence of cardiogenic shock postoperatively.

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