Hemodynamic derangements are defining features of cardiogenic shock. Randomized clinical trials have examined the efficacy of various therapeutic interventions, from percutaneous coronary intervention to inotropes and mechanical circulatory support (MCS). However, hemodynamic management in cardiogenic shock has not been well-studied. This State-of-the-Art review will provide a framework for hemodynamic management in cardiogenic shock, including a description of the 4 therapeutic phases from initial 'Rescue' to 'Optimization', 'Stabilization' and 'de-Escalation or Exit therapy' (R-O-S-E), phenotyping and phenotype-guided tailoring of pharmacological and MCS support, to achieve hemodynamic and therapeutic goals. Finally, the premises that form the basis for clinical management and the hypotheses for randomized controlled trials will be discussed, with a view to the future direction of cardiogenic shock.

2nd Department of Medicine Department of Cardiovascular Medicine 1st Faculty of Medicine Charles University Prague and General University Hospital Prague Czech Republic; Institute of Heart Diseases Wroclaw Medical University Wroclaw Poland

Advanced Heart Failure and Heart Transplant Unit Department of Cardiology Hospital Universitari de Bellvitge BIOHEART Cardiovascular Diseases Research Group Bellvitge Biomedical Research Institute Instituto Salud Carlos 3 Madrid Spain

Department of Cardiology Pulmonology and Vascular Medicine University Hospital Duesseldorf Duesseldorf Germany

Division of Cardiovascular Medicine University of Utah School of Medicine Salt Lake City Utah

Inova Schar Heart and Vascular Institute Inova Fairfax Medical Campus Falls Church Virginia

Institute of Cardiovascular Sciences University of Birmingham Birmingham UK; University Hospitals Birmingham NHS Foundation Trust Birmingham UK

University Heart and Vascular Centre Hamburg German Centre for Cardiovascular Research Partner Site Hamburg Kiel Lübeck Hamburg Germany

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