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Published on: June 12, 2021
Contemporary Management of Cardiogenic Shock During Pregnancy
Natalie Tapaskar1, Maxime Tremblay-Gravel2, Kiran K Khush1
1Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA.
Insights
Cardiogenic shock in pregnancy, often caused by peripartum cardiomyopathy, requires precise phenotyping for effective medical and mechanical therapy. Mechanical circulatory support, particularly extracorporeal membrane oxygenation, has improved survival rates for these critical cardiovascular conditions.
Area of Science:
- Cardiology
- Maternal-Fetal Medicine
- Critical Care Medicine
Background:
- Cardiogenic shock represents a severe cardiovascular compromise during pregnancy.
- Peripartum cardiomyopathy is the predominant etiology of cardiogenic shock in late pregnancy and postpartum.
- Effective management hinges on accurate phenotyping of shock, considering its cause, severity, and ventricular involvement.
Purpose of the Study:
- To review the current therapeutic strategies for cardiogenic shock in the context of peripartum cardiomyopathy.
- To highlight the role and efficacy of mechanical circulatory support in managing pregnant and postpartum patients with cardiogenic shock.
Main Methods:
- Literature review focusing on cardiogenic shock, peripartum cardiomyopathy, and mechanical circulatory support in pregnancy.
- Analysis of the application and outcomes of various mechanical circulatory support devices.
Main Results:
- Mechanical circulatory support devices, including intra-aortic balloon pumps, percutaneous ventricular assist devices, and extracorporeal circulatory devices, have been successfully employed.
- Extracorporeal membrane oxygenation is frequently utilized in pregnant patients.
- The implementation of mechanical circulatory support has correlated with enhanced survival rates in peripartum cardiomyopathy.
Conclusions:
- Mechanical circulatory support is a vital therapeutic option for cardiogenic shock in peripartum cardiomyopathy.
- Further research is necessary to establish optimal mechanical circulatory support strategies tailored to peripartum cardiomyopathy and associated cardiogenic shock.
Abstract:
Cardiogenic shock is the most extreme cardiovascular disease state during pregnancy. Peripartum cardiomyopathy is the most common cause of cardiogenic shock toward the end of pregnancy and in the early postpartum period. Therapy for cardiogenic shock relies on appropriate phenotyping of shock etiology, severity and ventricular predominance, which are critical in the appropriate selection of medical and mechanical therapy. Mechanical circulatory support may be used as a bridge to recovery or as definitive therapy. Intra-aortic balloon pumps, percutaneous left ventricular assist devices and venoarterial extracorporeal circulatory devices have been successfully used in pregnancy and the postpartum period. The most commonly used mechanical therapy in the pregnant patient is extracorporeal membranous oxygenation circulatory support. The use of mechanical circulatory devices in peripartum cardiomyopathy has contributed to improved survival rates in recent years. Further efforts to identify the optimal mechanical circulatory support strategy for peripartum cardiomyopathy and cardiogenic shock in the peripartum period are needed.
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