The prognosis of cardiogenic shock is still dismal despite advancements in diagnostic and therapeutic options. One of the major problems is the development of multi-organ failure caused by impaired organ perfusion with inadequate microcirculation. The diagnosis of cardiogenic shock is based on clinical signs of hypoperfusion, echocardiography, and hemodynamic parameters. Because of its high prognostic relevance microcirculation has become more interesting for clinicians recently. Signs of severe cardiogenic shock are reduced vascular density and impaired microflow, especially in the smallest vessels and the location of exchange of gas and nutrients. Recent studies revealed that intravital-microscopy is a valuable tool for on-line and in-vivo measuring of microcirculatory parameters. The assessment of microcirculation during modifications of the treatment of cardiogenic shock is valuable, e. g. during catecholamine therapy or when using of circulatory assist devices. This article summarizes new findings regarding microcirculation in cardiogenic shock, the use of assist devices, and novel pharmacological treatment. Evaluation of microcirculatory changes with its new insights in the complex pathophysiology of cardiogenic shock has the potential to become part of diagnostic algorithms.
Georg Thieme Verlag KG Stuttgart.New York.