Cochrane corner: inotropic agents and vasodilator strategies for cardiogenic shock or low cardiac output syndrome


Low cardiac output syndrome (LCOS) and cardiogenic shock (CS) represent life-threatening complications of acute myocardial infarction (AMI), heart failure (HF) or cardiac surgery. Clinically, LCOS presents with hypotension and end-organ hypoperfusion. In CS, the low system oxygen delivery is complicated by a multiorgan dysfunction, which necessitates immediate action. A main treatment strategy, therefore, aims at re-establishing an adequate macrocirculation and microcirculation for the improvement of cellular oxygen supply. Current medical drug therapy for haemodynamic stabilisation is based on vasoactive substances. In early stages, increased systemic vascular resistance often requires vasodilatory drugs, which mediate left ventricular unloading. Nevertheless, application of pure vasodilators might be restricted to certain subgroups of LCOS/CS under the condition of a guided haemodynamic monitoring.1 In the following states of LCOS/CS, therapeutic approaches are mainly based on positive inotropes, which mediate myocardial stimulation and increase heart contractibility. Inotropic drugs effectively enhance myocardial performance….

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