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WHO Definition of Palliative Care.Geneva: WHO;

clinical practice

Management of cardiogenic shock complicating ST-segment elevation myocardial infarction: part 2

02 March 2019
Features
02 March 2019
Volume 11 · Issue 3

Abstract

Cardiogenic shock is a leading cause of death in those experiencing ST-segment elevation myocardial infarction. The objective of therapeutic strategies is to preserve end-organ perfusion and reduce mortality. Prompt revascularisation by percutaneous coronary intervention or coronary artery bypass graft is considered the gold standard of care. Pharmacological and mechanical support is indicated in patients with persistent hypotension and evidence of end-organ hypoperfusion. However, there is a paucity of scientiĉ data regarding the best pharmacological agent or form of mechanical support. Prehospital care has a pivotal role in caring for these patients by monitoring them and providing physical and psychological support during transfer to acute care. Palliative care is complementary to curative therapies and should be perceived as integral to effective symptom management.

After completing this module the paramedic will be able to:

Cardiogenic shock is caused by a decrease in left ventricular function—this leads to persistent hypotension resulting in systemic end-organ hypoperfusion (Thiele et al, 2015; van Diepen et al 2017). It is associated with signs of organ hypoperfusion such as cool, clammy skin, altered mental status, oliguria and raised serum lactate in the presence of persistent hypotension despite adequate circulating volume. Acute ST-segment elevation myocardial infarction (STEMI) causing left ventricular dysfunction is the most common cause, accounting for approximately 80% of cases (Reynolds and Hochman, 2008).

Part one of this series outlined the pathophysiology, patient outcomes and diagnostic criteria associated with cardiogenic shock (O'Donovan, 2019). In part two, goals of care, evidence-based treatment strategies and the role of the paramedic will be discussed.

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