HEMODYNAMIC MANAGEMENT AND SUPPORTIVE THERAPIES IN THE TREATMENT OF CARDIOGENIC SHOCK

Abstract

Cardiogenic shock (CS) is a complex clinical syndrome resulting from primary heart pump failure, characterized by critical systemic hypoperfusion and associated with an alarming hospital mortality rate, ranging from 30% to 50%. Contemporary management requires a multidisciplinary and stratified approach, guided by the SCAI classification, and based on early hemodynamic stabilization with the judicious use of vasopressors and inotropes, invasive monitoring, and, in refractory cases, temporary mechanical circulatory support (tMCS). This study constituted a narrative literature review to synthesize the most recent evidence on hemodynamic management and supportive therapies in CS. The results highlight that precise hemodynamic monitoring, using a pulmonary artery catheter (PAC) and echocardiography, is essential to guide individualized treatment. Pharmacological support prioritizes norepinephrine as the first-line vasopressor, complemented by inotropes such as dobutamine and milrinone. Furthermore, the introduction of tMCS devices (BIA, Impella, VA-ECMO) has revolutionized the management of the most severe stages. It is concluded that the most effective management of cardiac shock combines rapid hemodynamic stabilization with vasopressors, invasive monitoring guided by CAP, and the strategic use of tMCS, always integrated with early revascularization (when applicable), requiring the implementation of clear and gradual protocols to address the patient's prognosis and complications.