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Therapie des kardiogenen Schocks bei akutem Herzinfarkt

Therapy of cardiogenic shock after myocardial infarction

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Zusammenfassung

Die Therapie des kardiogenen Schocks im Rahmen des akuten Myokardinfarkts beinhaltet neben der raschen Revaskularisation des Infarktgefäßes die schnellstmögliche Wiederherstellung eines ausreichenden Organperfusionsdrucks, um ein Multiorgandysfunktionssyndrom (MODS) zu vermeiden. Neben der Gabe von Katecholaminen haben hier Kreislaufunterstützungssysteme einen festen Stellenwert. Aufgrund der Komplexität und der technischen und personellen Aufwendungen, die für den Einsatz solcher Systeme notwendig sind, sollten Infarktpatienten mit kardiogenem Schock in entsprechenden kardiologischen Zentren behandelt werden. Zukünftige Entwicklungen kleinerer und mobiler Notfallsysteme werden die Möglichkeiten der schnellen hämodynamischen Stabilisierung sowie des sicheren Transports von kardiogenen Schockpatienten in der Zukunft weiter verbessern.

Abstract

The therapy of infarct related cardiogenic shock should primarily focus on fastest possible revascularization. In addition, rapid restoration of sufficient organ perfusion pressure is recommended for the prevention of a multi-organ dysfunction syndrome (MODS). This can be achieved by mechanical circulatory assist devices as well as individual catecholamine therapy. Since assist devices require specially trained physicians, their use is limited to specialized cardiac care centers. However, future technologies such as portable heart-lung-machines may help to further improve transfer to specialized centers and therapy of shock patients.

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Literatur

  1. Alexander JH, Reynolds HR, Stebbins AL et al. (2007) Effect of tilarginine acetate in patients with acute myocardial infarction and cardiogenic shock: the TRIUMPH randomized controlled trial. JAMA 297: 1657–1666

    Article  PubMed  CAS  Google Scholar 

  2. Anderson RD, Ohman EM, Holmes DR et al. (1997) Use of intraaortic balloon counterpulsation in patients presenting with cardiogenic shock: observations from the GUSTO-I study. global utilization of streptokinase and TPA for occluded coronary arteries. J Am Coll Cardiol 30: 708–715

    Article  PubMed  CAS  Google Scholar 

  3. Arntz HR, Bossaert L, Filippatos GS (2005) European resuscitation council guidelines for resuscitation 2005. Section 5. Initial management of acute coronary syndromes. Resuscitation 67: S87–S96

    Article  PubMed  Google Scholar 

  4. Babaev A, Frederick PD, Pasta DJ et al. (2005) Trends in management and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock. JAMA 294: 448–454

    Article  PubMed  CAS  Google Scholar 

  5. Bellomo R, Chapman M, Finfer S et al. (2000) Low-dose dopamine in patients with early renal dysfunction: a placebo-controlled randomised trial. Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group. Lancet 356: 2139–2143

    Article  PubMed  CAS  Google Scholar 

  6. Califf RM, Bengtson JR (1994) Cardiogenic shock. N Engl J Med 330: 1724–1730

    Article  PubMed  CAS  Google Scholar 

  7. Chen EW, Canto JG, Parsons LS et al. (2003) Relation between hospital intra-aortic balloon counterpulsation volume and mortality in acute myocardial infarction complicated by cardiogenic shock. Circulation 108: 951–957

    Article  PubMed  Google Scholar 

  8. Ferrari M, Aboulhosn W, Figulla HR (2005) Successful high-risk coronary angioplasty in a patient with cardiogenic shock under circulatory assist with a 16F axial flow pump. Catheter Cardiovasc Interv 66: 557–561

    Article  PubMed  Google Scholar 

  9. Ferrari M, Poerner TC, Brehm BR et al. (2008) First use of a novel plug-and-play percutaneous circulatory assist device for high-risk coronary angioplasty. Acute Cardiac Care 14: 111–115

    Article  Google Scholar 

  10. Garatti A, Colombo T, Russo C et al. (2004) Impella recover 100 microaxial left ventricular assist device: the Niguarda experience. Transplant Proc 36: 623–626

    Article  PubMed  CAS  Google Scholar 

  11. Hasdai D, Holmes DR, Topol EJ et al. (1999) Frequency and clinical outcome of cardiogenic shock during acute myocardial infarction among patients receiving reteplase or alteplase. Results from GUSTO-III. Global use of strategies to open occluded coronary arteries. Eur Heart J 20: 128–135

    Article  PubMed  CAS  Google Scholar 

  12. Hasdai D, Topol EJ, Califf RM et al. (2000) Cardiogenic shock complicating acute coronary syndromes. Lancet 356: 749–756

    Article  PubMed  CAS  Google Scholar 

  13. Hochman JS, Buller CE, Sleeper LA et al. (2000) Cardiogenic shock complicating acute myocardial infarction – etiologies, management and outcome: a report from the shock trial registry. should we emergently revascularize occluded coronaries for cardiogenic shock? J Am Coll Cardiol 36: 1063–1070

    Article  PubMed  CAS  Google Scholar 

  14. Hochman JS, Sleeper LA, Webb JG et al. (1999) Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock. N Engl J Med 341: 625–634

    Article  PubMed  CAS  Google Scholar 

  15. Hollenberg SM (2001) Cardiogenic shock. Crit Care Clin 17: 391–410

    Article  PubMed  CAS  Google Scholar 

  16. Hollenberg SM, Kavinsky CJ, Parrillo JE (1999) Cardiogenic shock. Ann Intern Med 131: 47–59

    PubMed  CAS  Google Scholar 

  17. Kalla K, Christ G, Karnik R et al. (2006) Implementation of guidelines improves the standard of care: the Viennese registry on reperfusion strategies in ST-elevation myocardial infarction (Vienna STEMI registry). Circulation 113: 2398–2405

    Article  PubMed  Google Scholar 

  18. Lane GE, Holmes DR (2000) Primary angioplasty for acute myocardial infarction in the elderly. Coron Artery Dis 11: 305–313

    Article  PubMed  CAS  Google Scholar 

  19. Levine GN, Hochman JS (1995) Thrombolysis in acute myocardial infarction complicated by cardiogenic shock. J Thromb Thrombolysis 2: 11–20

    Article  PubMed  CAS  Google Scholar 

  20. Mehlhorn U, Brieske M, Fischer UM et al. (2005) LIFEBRIDGE: a portable, modular, rapidly available „plug-and-play“ mechanical circulatory support system. Ann Thorac Surg 80: 1887–1892

    Article  PubMed  Google Scholar 

  21. Nieminen MS, Brutsaert D, Dickstein K et al. (2006) EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population. Eur Heart J 27: 2725–2736

    Article  PubMed  Google Scholar 

  22. Ryan JW, Peterson ED, Chen AY et al. (2005) Optimal timing of intervention in non-ST-segment elevation acute coronary syndromes: insights from the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines) registry. Circulation 112: 3049–3057

    Article  PubMed  Google Scholar 

  23. Silber S, Albertsson P, Aviles FF et al. (2005) Guidelines for percutaneous coronary interventions. The task force for percutaneous coronary interventions of the European Society of Cardiology. Eur Heart J 26: 804–847

    Article  PubMed  Google Scholar 

  24. Webb JG, Sanborn TA, Sleeper LA et al. (2001) Percutaneous coronary intervention for cardiogenic shock in the SHOCK Trial Registry. Am Heart J 141: 964–970

    Article  PubMed  CAS  Google Scholar 

  25. Webb JG, Sleeper LA, Buller CE et al. (2000) Implications of the timing of onset of cardiogenic shock after acute myocardial infarction: a report from the SHOCK Trial Registry. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock? J Am Coll Cardiol 36: 1084–1090

    Article  PubMed  CAS  Google Scholar 

  26. White HD, Assmann SF, Sanborn TA et al. (2005) Comparison of percutaneous coronary intervention and coronary artery bypass grafting after acute myocardial infarction complicated by cardiogenic shock: results from the Should We Emergently Revascularize Occluded Coronaries For Cardiogenic Shock (SHOCK) trial. Circulation 112: 1992–2001

    Article  PubMed  Google Scholar 

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Verbindungen hin:

Vortragshonorare der Firmen Abiomed (Impella), Datascope (IABP), Medtronic und Lifebridge (HLM, Notfallsystem).

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Authors and Affiliations

  1. Klinik für Innere Medizin I, Universitätsklinikum, Friedrich-Schiller-Universität, Erlanger Allee 101, 07747, Jena, Deutschland

    M. Ferrari & H.R. Figulla

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  1. M. Ferrari
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  2. H.R. Figulla
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Correspondence to M. Ferrari.

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Ferrari, M., Figulla, H. Therapie des kardiogenen Schocks bei akutem Herzinfarkt. Internist 49, 1047–1051 (2008). https://doi.org/10.1007/s00108-008-2076-1

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