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Review article
Available online 13 May 2022
Clinical management of postcardiotomy shock in adults
Manejo clínico del shock poscardiotomía en pacientes adultos
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J.L. Pérez Velaa,
Corresponding author
jpvela@salud.madrid.org

Corresponding author.
, C. Llanos Jorgeb, J. Duerto Álvarezc, J.J. Jiménez Riverad
a Servicio de Medicina Intensiva, Hospital Universitario Doce de Octubre, Madrid, Spain
b Servicio de Medicina Intensiva, Hospital Quirónsalud Tenerife, Santa Cruz de Tenerife, Spain
c Servicio de Medicina Intensiva, Hospital Universitario Clínico San Carlos, Madrid, Spain
d Servicio de Medicina Intensiva, Complejo Hospitalario Universitario de Canarias, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
Received 28 July 2021. Accepted 21 August 2021
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Tables (4)
Table 1. Characteristics of the inotropic drugs and vasopressors.
Table 2. Management of postcardiotomy cardiogenic shock/right ventricular failure.
Table 3. Indications and recommendations regarding mechanical circulatory support in postcardiotomy shock.
Table 4. Characteristics of the mechanical circulatory support systems.
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Abstract

Postcardiotomy cardiogenic shock represents the most serious expression of low cardiac output syndrome after cardiac surgery. Although infrequent, it is a relevant condition due to its specific and complex pathophysiology and important morbidity-mortality. The diagnosis requires a high index of suspicion and multimodal hemodynamic monitoring, where echocardiography and the pulmonary arterial catheter play a main role. Early and multidisciplinary management should focus on the management of postoperative or mechanical complications and the optimization of determinants of cardiac output through fluid therapy or diuretic treatments, inotropic drugs and vasopressors/vasodilators and, in the absence of a response, early mechanical circulatory support. The aim of this paper is to review and update the pathophysiology, diagnosis and management of postcardiotomy cardiogenic shock.

Keywords:
Postcardiotomy shock
Vasoplegia
Cardiac surgery
Mechanical circulatory support
Resumen

El shock cardiogénico poscardiotomía representa la situación clínica más grave del síndrome de bajo gasto poscirugía cardiaca. Aunque infrecuente, su fisiopatología específica y compleja y su elevada morbimortalidad lo convierten en una entidad especialmente relevante en el contexto de la medicina intensiva. El diagnóstico requiere un elevado índice de sospecha clínica y monitorización multimodal, con un papel fundamental para la ecocardiografía y el catéter de arteria pulmonar. Su manejo debe ser precoz, escalonado y dinámico, multisistémico, multidisciplinar, basado en resolver potenciales complicaciones mecánicas y optimizar los determinantes del gasto cardiaco mediante aporte de volumen o tratamiento deplectivo, fármacos inotrópicos y vasopresores/vasodilatadores y, en ausencia de respuesta, soporte circulatorio mecánico precoz. El objetivo de este artículo es presentar una revisión narrativa y una actualización de la fisiopatología, el diagnóstico y el manejo clínico del shock poscardiotomía. Además, se proponen pautas de actuación que faciliten el manejo clínico diario.

Palabras clave:
Shock postcardiotomía
Vasoplejia
Cirugía cardiaca
Soporte circulatorio mecánico

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