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Zur deutsch-österreichischen S3‑Leitline „Infarkt-bedingter kardiogener Schock – Diagnose, Monitoring und Therapie“

On the German-Austrian S3 guideline “Cardiogenic shock due to myocardial infarction: diagnosis, monitoring and treatment”

  • Evidenzbasierte Medizin
  • Published:
Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Der kardiogene Schock – meist Folge eines linksventrikulären Pumpversagens – ist die häufigste intrahospitale Todesursache bei akutem Herzinfarkt. Einen kardiogenen Schock erleiden 5–10 % aller Patienten mit Herzinfarkt, akut oder innerhalb der ersten Tage. Auch wenn sich aufgrund des häufigeren Einsatzes früher Revaskularisationsmaßnahmen ein Rückgang der Sterblichkeit abzeichnet, liegt diese bei etwa 40–50 % und ist zu mindestens zum Teil auf die überschießende systemische Inflammationsreaktion und das Multiorgandysfunktionssyndrom zurückzuführen. Aktuelle Herzinfarkt-Leitlinien fokussieren ihre Empfehlungen überwiegend auf die Behandlung der Koronarien und des Herz-Kreislauf-Systems, so dass es 2004 das Ziel war, unter Beteiligung deutscher und österreichischer wissenschaftlicher Fachgesellschaften, u. a. der DGTHG, die S3-Leitlinie „Infarkt-bedingter kardiogener Schock (IkS) – Diagnose, Monitoring und Therapie“ zu entwickeln. Dabei wurden v. a. Empfehlungen für die schnellstmögliche Revaskularisation, die Stabilisierung des Kreislaufs, die Gewährleistung einer adäquaten Oxygenierung zur Sicherstellung einer ausreichenden Perfusion und Sauerstoffversorgung der vitalen Organe sowie die supportive Behandlung des schockbedingten Multiorgandysfunktionssyndroms entwickelt. Als ein maßgeblicher Faktor für die Prognoseverbesserung des IkS wurde das enge Zusammenwirken von kardiologischer, kardiochirurgischer und intensivmedizinischer Kompetenz (Herz-Team) angesehen. Die Publikation dieser Leitlinie liegt nun 8 Jahre zurück, so dass eine Aktualisierung notwendig war. Der vorliegende Artikel soll einen ersten Überblick über die wichtigsten Änderungen sowie für den Herzchirurgen bzw. herzchirurgischen Intensivmediziner relevante Empfehlungen der Leitlinie geben.

Abstract

Despite advances in treatment mainly by early revascularization with subsequent mortality reduction, cardiogenic shock remains the leading cause of death in acute myocardial infarction with mortality rates still approaching 40–50%. Cardiogenic shock is characterized by a multiorgan dysfunction syndrome, often complicated by a systemic inflammatory response syndrome that affects outcome more than the decrease in cardiac contractile function; however, both European and American guidelines on myocardial infarction focus on cardiological/cardiosurgical aspects only. Therefore, experts from eight German and Austrian specialty societies including the German Society for Thoracic and Cardiovascular Surgery developed the German-Austrian S3 guideline “Cardiogenic shock due to myocardial infarction: diagnosis, monitoring and treatment” to give evidence-based recommendations for the diagnosis and treatment of ICS (infarction-related cardiogenic shock) between 2004 and 2010 covering the topics of early revascularization, revascularization techniques, intensive care unit treatment including ventilation, transfusion regimens, adjunctive medication, and mechanical support devices. Within the last 3 years, this guideline was updated as some major recommendations were out of date and new evidence exists. This review will therefore outline the management of patients with cardiogenic shock complicating acute myocardial infarction according to the updated guideline with a major focus on evidence-based recommendations being relevant for the cardiac surgeon and the cardiothoracic intensivist.

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Authors and Affiliations

  1. Klinik für Intensivmedizin, imland Klinik Rendsburg, Lilienstr. 20–28, 24768, Rendsburg, Deutschland

    K. Pilarczyk

  2. Klinik für Kardiovaskuläre Chirurgie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland

    U. Boeken

  3. Klinik für Thorax- und Kardiovaskuläre Chirurgie, Westdeutsches Herz- und Gefäßzentrum Essen, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland

    M. Thielmann

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Correspondence to K. Pilarczyk.

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K. Pilarczyk, U. Boeken und M. Thielmann geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Pilarczyk, K., Boeken, U. & Thielmann, M. Zur deutsch-österreichischen S3‑Leitline „Infarkt-bedingter kardiogener Schock – Diagnose, Monitoring und Therapie“. Z Herz- Thorax- Gefäßchir 33, 346–354 (2019). https://doi.org/10.1007/s00398-019-0311-9

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