Postoperative Cardiogenic Shock

2020 ◽  
pp. 343-352
Author(s):  
Maurice Hogan
Keyword(s):  
Cardiogenic Shock ◽  
Graft Failure ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Mechanical Support ◽  
Artery Bypass Graft ◽  
Fundamental Goal ◽  
Postoperative Myocardial Infarction ◽  
Assessment And Treatment ◽  
Definitive Management

Postoperative cardiogenic shock describes the management of a postoperative coronary artery bypass graft patient who develops early postoperative shock; after a brief discussion of the different potential causes, the chapter focuses on postoperative myocardial infarction due to graft failure. It reviews the assessment and treatment of patients with postoperative myocardial ischemia causing shock; it then outlines the immediate steps to take for diagnosis and patient stabilization, before discussing the definitive management strategy. A stepwise discussion covering fluids and pharmacological and mechanical support is provided to help guide management decisions. The chapter then outlines revascularization as the optimal treatment and fundamental goal.

scholarly journals ECMELLA: successful rescue cardiopulmonary support in post-coronary artery bypass graft cardiogenic shock with cardiac arrest—case report

2020 ◽  
Author(s):  
Zara Chan Nogueira ◽  
Sara Trevas ◽  
Hilaryano Ferreira ◽  
Hugo Côrte-Real
Keyword(s):  
Cardiac Arrest ◽  
Coronary Artery ◽  
Cardiogenic Shock ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Mechanical Support ◽  
Artery Bypass Graft ◽  
Graft Thrombosis ◽  
Cardiopulmonary Support ◽  
Va Ecmo

Abstract Background Cardiogenic shock is the main cause of death in hospitalized patients with acute coronary syndromes, with a high mortality rate. The management of graft thrombosis after coronary artery bypass graft (CABG) surgery is challenging and the best revascularization strategy is not well defined. In patients who develop cardiac arrest due to graft thrombosis, the benefits of mechanical support during advanced cardiac life support are uncertain. Rescue extracorporeal cardiac bypass resuscitation has been used in the context of cardiopulmonary arrest, with survival rates of around 34.7% of which 28.5% with good neurological outcome. Case summary We present here the case of a patient who developed cardiogenic shock after CABG graft occlusion. The patient suffered refractory cardiac arrest during percutaneous revascularization and received rescue cardiopulmonary support. Revascularization was achieved and there was a successful resuscitation with the placement of venous-arterial extracorporeal membrane oxygenation (VA-ECMO) and an Impella CP device. After a 29-day hospitalization the patient was discharged with no neurological sequelae. Discussion Although there is limited evidence of the benefit of a combined use of mechanical support (VA-ECMO with other mechanical devices) in the management of cardiogenic shock and cardiac arrest following CABG surgery, there seems to be a lower mortality with this approach, and possibly more favourable neurological outcomes. Further research is needed to elucidate the advantages of Impella vs. intra-aortic balloon pump combined with VA-ECMO in such patients.

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