I am posting a link to an excellent review article on Cardiogenic shock and its treatment. I enjoyed reading it.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4495097/
In analogy to septic shock, the target mean arterial pressure should be titrated to 65–70 mmHg, as a higher blood pressure is not associated with beneficial outcome with the exception of previously hypertensive patients.
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Norepinephrine should be used to restore perfusion pressure during cardiogenic shock (strong agreement).
The only randomized study comparing two types of vasopressors—norepinephrine and epinephrine—showed that, for the same hemodynamic efficacy, epinephrine was associated with a higher heart rate, more arrhythmia, and lactic acidosis [
11]. In a cohort study, De Backer et al. reported a reduction in mortality with norepinephrine when compared with dopamine [
12].
Lastly, norepinephrine-induced increase in blood pressure in patients with post-MI CS is associated with an increase in cardiac index without an increase in heart rate and with increased SvO2 and reduced blood lactate [
13].
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Epinephrine can be a therapeutic alternative to the combination of dobutamine and norepinephrine, but is associated with a greater risk of arrhythmia, tachycardia, and hyperlactatemia (weak agreement).
In terms of hemodynamic effect, epinephrine clearly increases cardiac output, essentially by a heart rate effect, but is associated with severe hyperlactatemia of metabolic origin that hampers interpretation of lactate as a marker of the adequacy of tissue perfusion [
14].
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Dobutamine should be used to treat low cardiac output in cardiogenic shock (strong agreement).