Related Experiment Video
Updated: Dec 7, 2025
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Cardiogenic Shock Management: International Survey of Contemporary Practices
Angie S Lobo1, Yader Sandoval, Jose P Henriques
1Minneapolis Heart Institute, 920 East 28th Street #300, Minneapolis, MN 55407 USA. esbrilakis@gmail.com.
Insights
Cardiogenic shock (CS) management varies widely, with many centers lacking advanced resources. This survey highlights significant differences in care and suggests a need for standardized CS treatment protocols and improved access to cardiac rehabilitation.
Area of Science:
- Cardiology
- Intensive Care Medicine
- Clinical Research
Background:
- Limited data exist on current cardiogenic shock (CS) management strategies.
- Understanding contemporary CS care is crucial for improving patient outcomes.
Purpose of the Study:
- To survey current practices and resource availability for cardiogenic shock (CS) management.
- To identify variations in diagnosis, treatment, and support systems for CS patients.
Main Methods:
- A 48-item survey was distributed to physicians involved in cardiogenic shock care.
- The survey included questions on diagnosis, management strategies, available resources, and utilization of specific interventions.
- Data were collected from 211 respondents, including interventional cardiologists, general cardiologists, intensivists, and surgeons.
Main Results:
- Significant variation in practice was observed, with many sites lacking advanced heart failure support, on-site cardiac surgery, or 24/7 percutaneous coronary intervention (PCI) coverage.
- Protocols for CS management, use of hemodynamic monitoring (arterial lines, pulmonary artery catheters), and choice of vasopressors/inotropes (norepinephrine preferred) showed considerable diversity.
- Practices regarding coronary angiography and PCI, including revascularization strategies and timing of mechanical circulatory support (MCS) implementation, varied widely. Availability of percutaneous MCS devices (IABP, Impella, ECMO, TandemHeart) also differed.
- Most respondents did not use risk stratification scoring systems, and a majority reported a lack of CS-specific cardiac rehabilitation programs.
Conclusions:
- Wide variations in care delivery and available resources for cardiogenic shock (CS) patients were identified.
- The findings suggest significant opportunities for standardizing CS care and improving resource allocation.
- Enhancing access to advanced therapies and cardiac rehabilitation programs is essential for optimizing CS patient management.
Background:
Limited data exist on current cardiogenic shock (CS) management strategies.
Methods:
A 48-item open- and closed-ended question survey on the diagnosis and management of CS.
Results:
A total of 211 respondents (3.2%) completed the survey, including 64% interventional cardiologists, 14% general cardiologists, 11% advanced heart failure cardiologists, 5% intensivists, 3% cardiothoracic surgeons; the remainder were internists, emergency medicine, and other physicians. Nearly half (45%) reported practicing at sites without advanced heart failure support/resources, with neither durable ventricular assist devices nor heart transplant available; 16% practice at sites without on-site cardiac surgery and 6% do not offer 24/7 percutaneous coronary intervention (PCI) coverage. The majority (70%) practice in closed intensive care units with multidisciplinary rounding (73%), cardiologists frequently involved in patient care (89%), and involving cardiology-intensivist co-management (41%). Over half (55%) reported use of CS protocols, 61% reported routine arterial line use, 25% reported routine use of pulmonary artery catheter use to guide management and 9% did not. The preferred vasopressor and/or inotrope was norepinephrine (68%). For coronary angiography and PCI, 53% use transradial access, 72% only revascularize the culprit vessel, and 44% institute mechanical circulatory support (MCS) prior to revascularization. Percutaneous MCS availability was as follows: intra-aortic balloon pump (92%), Impella (78%), peripheral veno-arterial extracorporeal membrane oxygenation (66%), and TandemHeart (28%). Most respondents (58%) do not use a scoring system for risk stratification and most (62%) reported that CS-specific cardiac rehabilitation programs were unavailable at their sites.
Conclusion:
Wide variation exists in the care delivered and/or resources available for patients with CS. Our survey suggests opportunities for standardization of care.
Related Concept Videos
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:24Blood Pressure Imbalances and Circulatory Shock
Blood Pressure: Hypertension and Hypotension
Normal blood pressure is 120/80 mm Hg. Elevated blood pressure is 120-129/under 80 mm Hg. Hypertension, warranting treatment at 130/80 mm Hg, is often asymptomatic and can lead to severe cardiovascular events, aneurysms, peripheral arterial disease, chronic renal disease, or cardiac...
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:29Cardiomyopathy V: Interprofessional Care
01:26Acute Coronary Syndrome V: Nursing Management