Annals of Intensive Care volume 14 , Article number: 45 Cite this article. Metrics details. Cardiogenic shock CS is characterized by low cardiac output and sustained tissue hypoperfusion that may result in end-organ dysfunction and death.
CS is associated with high short-term mortality, and its management remains challenging despite recent advances in therapeutic options. Timely diagnosis and multidisciplinary team-based management have demonstrated favourable effects on outcomes. We aimed to review evidence-based practices for managing patients with ischemic and non-ischemic CS, detailing the multi-organ supports needed in this critically ill patient population.
Cardiogenic shock CS is a life-threatening syndrome defined by peripheral hypoperfusion and organ dysfunction due to primary cardiac dysfunction. It has several underlying aetiologies, the most common being acute myocardial infarction AMI. Other less common causes include de novo subtypes of CS fulminant myocarditis, right ventricular [RV] failure, Takotsubo syndrome, post-partum cardiomyopathy, end-stage valvular heart disease and acute decompensation of other cardiomyopathies [ 1 ].
CS is defined as clinical and biological evidence of tissue hypoperfusion secondary to cardiac dysfunction [ 3 ]. However, the use of "one size fits all" definitions does not account for the CS hemodynamic phenotypes which can vary from those with myocardial dysfunction due to ischemia requiring minimal vasopressor support to CS with ongoing cardiac arrest. This classification has been validated in a large cohort of unselected cardiac ICU patients, showing a strong association between SCAI shock stages and mortality, even after adjustment for known predictors of mortality [ 4 ].
A second classification focusing on hemodynamic parameters classifies patient into four separates states according to their status volume and their peripheral circulation Fig. In detail, the non-congested phenotype I exhibits lower heart rate, normal filling pressures right atrial and pulmonary capillary wedge pressures , and a higher blood pressure relative to the other phenotypes, representing a relatively stable profile of a non-congested patient with CS.
