Macrovascular Hemodynamics and Peripheral Perfusion in Cardiogenic Shock

Abstract

Despite significant advances in care over the past few decades, mortality among patients with cardiogenic shock (CS) remains up to 50%. Given the persistently high mortality, there is an urgent need for both better prognostic tools and treatment strategies. The pathophysiology of CS has major contributions from both macrovascular and microvascular dysfunction, but therapies are titrated toward the more readily measurable metrics (ie, mean arterial pressure, cardiac index, etc) under the assumption that both macrovascular and microvascular dynamics will respond to intervention in tandem. However, emerging evidence suggests that macrovascular and microvascular circulatory functions are not always aligned, particularly in those with critical illness. This review summarizes the significance of different macrovascular and microvascular metrics in CS, drawing from a robust field of evidence to demonstrate the promising role that microvascular tissue perfusion markers play in management of patients with CS and summarize the current understanding of this burgeoning field.