SURGERY AND COUNTERPULSATION IN CARDIOGENIC SHOCK

This paper records our experience with patients in cardiogenic shock managed by counterpulsation, with or without surgery. The early experience was disappointing, as all six patients so managed died. The definition of cardiogenic shock was then liberalized. This resulted in much earlier Induction of counterpulsation and earlier assessment. Eight patients were managed and five survived, two following counterpulsation alone, and three following counterpulsation and surgery. Counterpulsation was used to support the heart over a long period of time, to stabilize patients during diagnostic procedures and preparation for surgery, and as an effective means of postoperative support. Cardioangiographic examination is a safe, valuable and essential method of assessment. Haemoperi–cardium can cause profound shock, is elusive of diagnosis, and can be the result of cardiac rupture or bleeding from the surface of an infarct. The latter might well be heparin induced. It can safely and easily be managed by surgery. The value of revascularization procedures is still in doubt. Revascularization was carried out only when patent distal vessels could be demonstrated by coronary arteriographic examination.