Vasoactive management of cardiogenic shock profiles
| Cause/presentation of CS | Vasoactive management considerations and rationale |
| ‘Classic’ cold and wet | First line: norepinephrine for initial haemodynamic stabilisation (preferred as less arrhythmogenic). Following BP control the addition of inotropic agent should be considered. |
| Euvolaemic cold and dry | First line: norepinephrine, followed by addition of inotropic agent. LVEDP may be low and respond to judicious filling. |
| Mixed warm and wet | Complicated clinical picture. Consider PAC. Norepinephrine should be first-line agent with use of subsequent vasoactive agents guided by clinical and haemodynamic assessment. |
| Right ventricular failure | Maintain preload with careful fluid boluses. Norepinephrine to maintain RV coronary perfusion. Consider chronotrope if relatively bradycardic (HR <70 bpm). Vasopressin may increase SVR with equivocal effect on PVR. Inotropic support following initial stabilisation. Use of pulmonary vasodilators if PVR high. |
Norepinephrine should generally be regarded as the first-line vasopressor.
BP, blood pressure; bpm, beats per minute; CS, cardiogenic shock; HR, heart rate; LVEDP, left ventricular end diastolic pressure; PAC, pulmonary artery catheter; PVR, pulmonary vascular resistance; RV, right ventricle; SVR, systemic vascular resistance.