Hemodynamic monitoring in cardiogenic shock

Abstract

Cardiogenic shock associates hypoxia and organs hypoperfusion with inadequate cardiac output. Hemodynamically, there are variable presentations depending on the type and degree of cardiac and vascular damage. Patient morbidity and mortality remain high despite improvements in the management of acute coronary syndromes. Hemodynamic monitoring has multiple objectives: it characterizes and assesses the severity of cardiac involvement, identifies the presence or absence of associated vascular dysfunction, identifies and monitors the evolution of peripheral organs and tissues perfusion, and finally guides the prescription of the various treatments (inotropes, vasopressors, circulatory assistance). The electrocardiogram, invasive blood pressure measurement, lactatemia, venous oxygen saturation, renal and hepatic functions monitoring or echocardiography are tools considered as routine. The pulmonary arterial catheter and transpulmonary thermodilution are advanced monitoring tools for refractory shock. Of course, there is no perfect tool for all hemodynamic parameters. This update aims to present all the monitoring tools recommended by the scientific societies.