Abstract
Despite diagnostic and therapeutic improvements, mortality rates in patients with cardiogenic shock remain relatively high. Several studies showed that cardiogenic shock is associated with alterations in the microvascular circulation. These alterations may be reversed by extracorporeal support devices. A study by Munsterman and colleagues adds to the body of evidence showing that in patients deemed ready for discontinuing intra-aortic balloon pump (IABP) support, microcirculatory flow in small vessels increases after ceasing IABP therapy. This study not only highlights the need for optimal timing of weaning from IABP support but also supports recent findings that global hemodynamics do not necessarily result in changes of microvascular perfusion. All modalities of modern treatment in cardiogenic shock need to be evaluated for their effect on the microcirculation. Microcirculatory evaluations should be part of randomized controlled trial protocols. More effort is needed to improve outcomes and understand the microcirculation as a therapy target and not as a silent bystander.
Highlights
Despite diagnostic and therapeutic improvements, mortality rates in patients with cardiogenic shock remain relatively high
Munsterman and colleagues show that in patients deemed ready for discontinuing intra-aortic balloon pump (IABP) support, microcirculatory flow in small vessels increases after ceasing IABP therapy
The authors conclude that IABP impairs microvascular perfusion in hemodynamically recovered patients
Summary
Despite diagnostic and therapeutic improvements, mortality rates in patients with cardiogenic shock remain relatively high. Percutaneous coronary intervention (PCI), inotropes, fluids, adjunctive medication, intra-aortic balloon pump (IABP), and ventricular assist devices are widely available, mortality rates in patients with CS remain high (40% to 50%). In CS, microvascular alterations have been observed, resulting in a decrease of vessel density, the proportion of perfused capillaries, or microvascular flow [3,4]. Different treatment strategies, including pharmacological interventions and mechanical assist devices, may lead to microcirculatory improvement in CS [5,6,7].
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