• Karl Werdan, Michael Buerke, Alexander Geppert, Holger Thiele, Bernd Zwissler, Martin Ruß, and guideline group*.
• * Guideline group see eBox 1; Department of Internal Medicine III, University Hospital Halle (Saale), Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany; Department of Cardiology, Angiology and Internal Intensive Care Medicine, St. Marienkrankenhaus Siegen, Siegen, Germany; Department of Cardiology, Clinic Ottakring, Vienna Healthcare Group, Vienna, Austria; Department of Cardiology, University of Leipzig, Heart Center Leipzig, Leipzig, Germany; Department of Anesthesiology, University Hospital, LMU, Munich, Germany; Internists at the Maxplatz, Traunstein/Affiliate Cardiology Traunstein, Traunstein, Germany.
• Dtsch Arztebl Int. 2021 Feb 12; 118 (6): 88-95.

BackgroundThe second edition of the German-Austrian S3 guideline contains updated evidence-based recommendations for the treatment of patients with infarction-related cardiogenic shock (ICS), whose mortality is several times higher than that of patients with a hemodynamically stable myocardial infarction (1).MethodsIn five consensus conferences, the experts developed 95 recommendations-including two statements-and seven algorithms with concrete instructions.ResultsRecanalization of the coronary vessel whose occlusion led to the infarction is crucial for the survival of patients with ICS. The recommended method of choice is primary percutaneous coronary intervention (pPCI) with the implantation of a drug-eluting stent (DES). If multiple coronary vessels are diseased, only the infarct artery (the "culprit lesion") should be stented at first. For cardiovascular pharmacotherapy-primarily with dobutamine and norepinephrine-the recommended hemodynamic target range for mean arterial blood pressure is 65-75 mmHg, with a cardiac index (CI) above 2.2 L/min/m2. For optimal treatment in intensive care, recommendations are given regarding the type of ventilation (invasive rather than non-invasive, lungprotective), nutrition (no nutritional intake in uncontrolled shock, no glutamine supplementation), thromboembolism prophylaxis (intravenous heparin rather than subcutaneous prophylaxis), und further topics. In case of pump failure, an intra-aortic balloon pump is not recommended; temporary mechanical support systems (Impella pumps, veno-arterial extracorporeal membrane oxygenation [VA-ECMO], and others) are hemodynamically more effective, but have not yet been convincingly shown to improve survival.ConclusionCombined cardiological and intensive-care treatment is crucial for the survival of patients with ICS. Coronary treatment for ICS seems to have little potential for further improvement, while intensive-care methods can still be optimized.

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