Management of cardiogenic shock in the infant: pathophysiology and treatments

Abstract

Cardiogenic shock is an acute circulatory failure related to impaired myocardial contractility responsible for a decrease in cardiac output and pulmonary congestion (edema). This situation, directly related to the myocardial incompetence, is a mismatch between the supply and demand for oxygen and nutrients from tissues. The definition of cardiogenic shock meets very strict criteria in adults and is based primarily on invasive hemodynamic measurements. Its definition in infants and children is rather based on clinical signs including signs of shock (decrease in blood pressure [not essential to the diagnosis], oliguria, extended capillary refill time, and altered consciousness) and myocardial incompetence. Like in adults, echocardiography plays a key role in the diagnosis. However, despite differences in definition, cardiogenic shock is, also in children, the final stage of myocardial alteration (heart failure). It can occur in patients with a past medical history of heart disease or not, follow or be associated with septic shock. Treatment should correct any reversible cause and be based on early and preventive actions to avoid cardiac failure. Its main objective is to establish an efficient myocardial contractility and sufficient filling pressures.