Elsevier

Mayo Clinic Proceedings

Volume 97, Issue 12, December 2022, Pages 2333-2354
Mayo Clinic Proceedings

Review
Contemporary Management of Concomitant Cardiac Arrest and Cardiogenic Shock Complicating Myocardial Infarction

https://doi.org/10.1016/j.mayocp.2022.06.027Get rights and content

Abstract

Cardiogenic shock (CS) and cardiac arrest (CA) are the most life-threatening complications of acute myocardial infarction. Although there is a significant overlap in the pathophysiology with approximately half the patients with CS experiencing a CA and approximately two-thirds of patients with CA developing CS, comprehensive guideline recommendations for management of CA + CS are lacking. This paper summarizes the current evidence on the incidence, pathophysiology, and short- and long-term outcomes of patients with acute myocardial infarction complicated by concomitant CA + CS. We discuss the hemodynamic factors and unique challenges that need to be accounted for while developing treatment strategies for these patients. A summary of expert-based step-by-step recommendations to the approach and treatment of these patients, both in the field before admission and in-hospital management, are presented.

Abbreviations and Acronyms

ABI
anoxic brain injury
ACLS
advanced cardiac life support
AMI
acute myocardial infarction
AMICS-CA
acute myocardial infarction complicated by cardiogenic shock and cardiac arrest
CA
cardiac arrest
CAD
coronary artery disease
CASC
cardiac arrest and shock center
CS
cardiogenic shock
ECMO
extra corporeal membrane oxygenation
ECPR
extra corporeal membrane oxygenation–assisted cardiopulmonary resuscitation
IABP
intra-aortic balloon pump
MAP
mean arterial pressure
MCS
mechanical circulatory support
NSTEMI
non–ST-segment elevation myocardial infarction
OHCA
out of hospital cardiac arrest
PAC
pulmonary artery catheter
PAMD
post arrest myocardial dysfunction
PEA
pulseless electrical activity
pLVAD
percutaneous left ventricular assist disease
PPCI
primary percutaneous coronary intervention
ROSC
return of spontaneous circulation
SCAI
society for cardiovascular angiography and interventions
STEMI
ST-segment elevation myocardial infarction
TTM
targeted temperature management
VF
ventricular fibrillation
VT
ventricular tachycardia

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