Table 2 Impact on macro- and microcirculation of drug and mechanical circulatory support devices used in cardiogenic shock
Drugs/MCS devices | Mechanism of action | Study protocol | Effects on macrocirculation described in the study | Effects on microcirculation described in the study | Study [Ref] |
|---|---|---|---|---|---|
Dobutamine | β1 adrenergic receptor agonist | Dobutamine was given when CI was < 2.2 L/min/m2 or SvO2 was < 65% | Increase HR, CI and SvO2 Slight reduction of PAOP | No effect on microcirculation | Den Uil et al., PMID: 25084171 |
Levosimendan | Myofilament calcium sensitizer | Â | Â | No study in cardiogenic shock | (An abstract, published in German in 2009 in Clin Res Cardiol seems to show improvement of microcirculation) |
Milrinone | Phosphodiesterase-3 inhibitors increasing intracellular calcium by inhibiting the degradation of cAMP | Â | Â | No study in cardiogenic shock | Â |
Enoximone | Phosphodiesterase-3 inhibitors increasing intracellular calcium by inhibiting the degradation of cAMP | Enoximone was given when CI was < 2.2 L/min/m2 or SvO2 was < 65% | Decrease CVP and PAOP | Increase PCD | Den Uil et al., PMID: 25084171 |
Norepinephrine | α1 and β1 adrenergic receptor agonist | Norepinephrine was given to patients when MAP was < 60 mmHg, independent of CI or SvO2, to reach a target MAP ≥ 70 mmHg | Increase MAP | Slight non-significant reduction of PCD | Den Uil et al., PMID: 25084171 |
Norepinephrine was given to increase MAP from 65–70 to 80–85 mmHg | Increase MAP | Increase delta StO2 and StO2 recovery slope (NIRS) | Perez et al., PMID: 24509521 | ||
Epinephrine | Stimulates both α1 and β1 adrenergic receptors |  |  | No study in cardiogenic shock |  |
Nitroglycerin | Organic nitrate providing an exogenous source of NO | Infusion was started at 8 µg/min and then doubled every 30 min up to 133 µg/min | Increase CI Decrease MAP, CVP and PAOP | Increase in PCD | Den Uil et al., PMID: 19639300 |
IABP | Intra-aortic balloon inflating during diastole to increase coronary perfusion and deflating during systole to decrease afterload | IABP was inserted in AMICS | Effect on microcirculation not described in this study | No effect on microcirculation | Jung et al., PMID: 25720332 |
IABP was withdrawn in recovering CS patients | Withdrawal of IABP led to a decrease in MAP and an increase in diastolic arterial pressure | Withdrawal of IABP led to an increased PVD | Munsterman et al., PMID: 20738876 | ||
Intentional stop of IABP support in CS | Effect on microcirculation not described in this study | IABP stop led to a decrease MFI | Jung et al., PMID: 19367424 | ||
VA-ECMO | Percutaneous cardiopulmonary bypass providing full hemodynamic support and increasing afterload | VA-ECMO implantation in refractory CS | Reduce HR and LVEF | Increase PPV, MFI and perfused SVD | Chommeloux et al., PMID: 31634235 |
Under VA-ECMO: increasing dobutamine above 5 μg/kg/min or VA-ECMO flow | While increasing dobutamine: increase HR and AoVTI While increasing VA-ECMO-flow: increase HR | No effect on microcirculation while increasing dobutamine or VA-ECMO-flow | Chommeloux et al., PMID: 35700546 | ||
Under VA-ECMO inserted within 48 h: increasing VA-ECMO pump flow or decreasing VA-ECMO pump flow | No change in MAP while increasing VA-ECMO pump flow | Both contradictory and non-contradictory responses of sublingual microcirculation Probability of increasing PVD after increasing VA-ECMO pump flow were higher in the events with a PVD < 15 mm/mm2 at baseline | Wei et al., PMID: 33898485 | ||
Under VA-ECMO in patient with MAP < 60 mmHg: inotropic and vasopressor agents (dopamine, dobutamine, norepinephrine or epinephrine) were administered to target and maintain a MAP at 60–90 mmHg | Increase HR and MAP | No differences were observed in Thenarmuscle StO2 and cerebral rSO2 Thenar muscle StO2 desaturation slope and resaturation slopes during the vessel obstruction test were also unchanged | Du et al., PMID: 27983541 | ||
Impella | Temporary percutaneous LVAD with a nonpulsatile axial flow pump that propels blood from the left ventricle into the ascending aorta through the catheter | Impella LP2.5 was inserted after PCI for a first anterior STEMI (No CS in this study but acute heart failure) | Increase LVEF | Increase PVD and MFI | Lam et al., PMID: 19280085 |