Cardiogenic shock (CS) is an end-organ hypoperfusion associated with heart failure. Any reason impairing acute left ventricular (LV) or right ventricular (RV) function may cause CS. The only way to avoid CS is to provide early reperfusion in myocardial infarction (MI) patients. CS is characterized by permanent or transient rearrangement of the entire circulatory system. According to the current IABP-SHOCK II trial, 74% of the patients with CSMI are treated with norepinephrine, 53% of them with dobutamine, 26% of them with epinephrine, 4% of them with levosimendan, and 4% of them with dopamine. Percutaneous circulatory support devices such as intra-aortic balloon pump (IABP), LV assist device (LVAD), or extracorporeal life support (ECLS) create treatment options for selected patients such as CS, cardiopulmonary resuscitation, or high-risk pPCI and CABG. Extracorporeal Life Support Organization (ELSO, 2017) evaluated that the use of ECLS/VA-ECMO should be considered when the mortality risk exceeds 50% despite optimal conventional treatment in case of acute severe heart or pulmonary failure, whereas it should be assessed as a primary indication when it exceeds 80%. Early and effective revascularization is the best treatment option for CS. Thus, the organizations on the national and global basis will play the most effective role for the short- and long-term survival of patients.
Part of the book: Advances in Extra-corporeal Perfusion Therapies
Hemorrhagic shock is a type of hypovolemic shock, where intravascular blood loss and consequent alterations in the cell due to the hypoxia result in tissue and organ dysfunction, leading to death, once a certain threshold level is exceeded. Inadequate oxygen delivery results with Na/K ATPase pump dysfunction and cell death by this way, but erythrocytes do not use oxygen for their survival. A depolarizing protein can be a reason under in vivo conditions. In severe injury, rapid loss of 25% and more blood volume cause irreversible shock. For blood restoration, crystalloid solutions temporarily provide a practical approach, but they cannot replace the lost erythrocyte mass occurred due to bleeding, and they have no therapeutic value. Excessive use causes several problems, especially coagulopathy and increases the mortality risk. The prompt transfer of patient to an ultimate center for treatment, use of blood and blood products in the treatment, and a swift restoration of hemorrhage source are essential. Tourniquet use in the extremities and balloon occlusion of the aorta can be lifesaving.
Part of the book: Clinical Management of Shock
Hemostasis in cardiac surgery is still a severe problem for surgeons. Blood and its products are the most valuable at the same time dangerous arms of surgeons. Industries produced many biological or non-biological products, which increase the cost of operations, are available for this issue. Decision making and producing solutions must be the most important properties of a cardiac surgeon. In any condition and resources, true strategy and patience will bring the success. Antiaggregants and anticoagulants are widely used agents, and in emergency or early cases, surgeons have to operate these patients. Both groups of drugs are growing, and in an emergency position, it is hard to know which drugs the patient using or given and what kind of medical status he/she has. For example non vitamin-K oral anticoagulants newer drugs and not known so much except cardiologists and cardiovascular surgeons. Simple solutions may have better results. Of course, in some conditions, urgent consultation can solve the problem. Cardiac surgeons have to figure out the problem by using their experience and surgical materials. Working as a team is a big advantage, more than one surgeon, experienced operation nurses and closer follow up in intensive care unit.