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Thorac Cardiovasc Surg 2021; 69(08): 684-692
DOI: 10.1055/s-0040-1719155
Original Cardiovascular

The German–Austrian S3 Guideline “Cardiogenic Shock Due to Myocardial Infarction: Diagnosis, Monitoring, and Treatment”

Kevin Pilarczyk
1   Imland Hospital Rendsburg, Department for Intensice Care Medicine, Rendsburg, Schleswig-Holstein, Germany
,
Karl Werdan
2   Department of Internal Medicine III, Heart Center, Martin-Luther-University Halle-Wittenberg, University Hospital, Germany
,
Martin Russ
3   Department of Cardiology, Traunstein Hospital, Traunstein, Germany
,
Holger Thiele
4   University of Leipzig-Heart Center, Department of Internal Medicine/Cardiology, Leipzig, Germany
,
Guido Michels
5   Department of Acute and Emergency Care, St.-Antonius-Hospital gGmbH, Eschweiler, Germany
,
Udo Boeken 
6   Department of Cardiac Surgery, University Hospital, Moorenstrasse 5, Duesseldorf, Germany
,
Matthias Thielmann
7   Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
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Abstract

Despite advances in the treatment of acute myocardial infarction with subsequent mortality reduction, which are mainly caused by the early timing of revascularization, cardiogenic shock still remains the leading cause of death with mortality rates still approaching 40 to 50%. Cardiogenic shock is characterized by a multiorgan dysfunction syndrome, often complicated by a systemic inflammatory response syndrome that affects the outcome more than the reduction of the cardiac contractile function. However, both European and American guidelines on myocardial infarction focus on interventional or surgical aspects only. Therefore, experts from eight German and Austrian specialty societies including the German Society for Thoracic and Cardiovascular Surgery published the German–Austrian S3 guideline “cardiogenic shock due to myocardial infarction: diagnosis, monitoring, and treatment” to provide evidence-based recommendations for the diagnosis and treatment of infarction-related cardiogenic shock in 2010 covering the topics of early revascularization, revascularization techniques, intensive care unit treatment including ventilation, transfusion regimens, adjunctive medical therapy, and mechanical support devices. Within the last 3 years, this guideline was updated as some major recommendations were outdated, or new evidence had been found. This review will therefore outline the management of patients with cardiogenic shock complicating acute myocardial infarction according to the updated guideline with a major focus on evidence-based recommendations which have been found relevant for cardiac surgery.

Keywords

cardiogenic shock - myocardial infarction - guideline - percutaneous coronary intervention - coronary artery bypass graft - extracorporeal - multiorgan dysfunction syndrome - extracorporeal membrane oxygenation - intra-aortic balloon counterpulsation - ventricular assist device

Author's Contribution

All authors participated sufficiently in the work to take public responsibility for the content. K.W. and M.R. designed the research/study and analyzed data. K.P., K.W., M.R., H.T., G.M., U.B., and M.T. performed study research. K.P., U.B., M.T. wrote the paper. U.B., H.T., and K.W. did the supervision and all the authors did the critical revision of the manuscript.




Publication History

Received: 20 September 2020

Accepted: 25 September 2020

Article published online:
24 December 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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