Preemptive renal replacement therapy in post-cardiotomy cardiogenic shock patients: a new concept?

摘要

Post-cardiotomy cardiogenic shock (PCCS) is a much-feared complication of cardiopulmonary bypass (CPB). It can lead to low cardiac output ( ) and/or low systemic vascular resistance syndromes ( ) requiring inotropic and vasopressor drugs to restore adequate hemodynamic status. In addition to the known risk factors for PCCS established in the literature ( , ), other factors may also come into play during surgery. For example, exposure of blood to non-physiologic surfaces, organ ischemia–reperfusion and/or endotoxin release during surgery with CPB can induce an intense systemic inflammatory response syndrome ( , ). In summary, PCCS has been identified as a major morbid event, associated with multiple organ failure, including prolonged respiratory failure and acute kidney injury (AKI), and 20–50% mortality ( - ).