PURPOSE OF REVIEW: Cardiogenic shock is a clinical syndrome with different causes and a complex pathophysiology. Recent evidence from clinical trials evokes the urgent need for redefining clinical diagnostic criteria to be compliant with the definition of cardiogenic shock and current diagnostic methods. RECENT FINDINGS: Conflicting results from randomized clinical trials investigating mechanical circulatory support in patients with cardiogenic shock have elicited several extremely important questions. At minimum, it is questionable whether survivors of cardiac arrest should be included in trials focused on cardiogenic shock. Moreover, considering the wide availability of ultrasound and hemodynamic monitors capable of arterial pressure analysis, the current clinical diagnostic criteria based on the presence of hypotension and hypoperfusion have become insufficient. As such, new clinical criteria for the diagnosis of cardiogenic shock should include evidence of low cardiac output and appropriate ventricular filling pressure. SUMMARY: Clinical diagnostic criteria for cardiogenic shock should be revised to better define cardiac pump failure as a primary cause of hemodynamic compromise.

2nd Department of Medicine Department of Cardiovascular Medicine 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Department of Cardiology 2nd Faculty of Medicine Charles University and Motol University Hospital

See more in PubMed

McDonagh TA, Metra M, Adamo M, et al. . 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021; 42:3599–3726. PubMed

Henry TD, Tomey MI, Tamis-Holland JE, et al. . Invasive management of acute myocardial infarction complicated by cardiogenic shock: a scientific statement from the American Heart Association. Circulation 2021; 143:e815–e829. PubMed

Naidu SS, Baran DA, Jentzer JC, et al. . SCAI SHOCK Stage Classification Expert Consensus Update: A Review and Incorporation of Validation Studies: this statement was endorsed by the American College of Cardiology (ACC), American College of Emergency Physicians (ACEP), American Heart Association (AHA), European Society of Cardiology (ESC) Association for Acute Cardiovascular Care (ACVC), International Society for Heart and Lung Transplantation (ISHLT), Society of Critical Care Medicine (SCCM), and Society of Thoracic Surgeons (STS) in December 2021. J Am Coll Cardiol 2022; 79:933–946. PubMed

Heidenreich PA, Bozkurt B, Aguilar D, et al. . 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022; 145:e895–e1032. PubMed

Berg DD, Bohula EA, Morrow DA. Epidemiology and causes of cardiogenic shock. Curr Opin Crit Care 2021; 27:401–408. PubMed

Brunner S, Guenther SPW, Lackermair K, et al. . Extracorporeal life support in cardiogenic shock complicating acute myocardial infarction. J Am Coll Cardiol 2019; 73:2355–2357. PubMed

Ostadal P, Rokyta R, Karasek J, et al. . Extracorporeal membrane oxygenation in the therapy of cardiogenic shock: results of the ECMO-CS randomized clinical trial. Circulation 2023; 147:454–464. PubMed

Banning AS, Sabate M, Orban M, et al. . Venoarterial extracorporeal membrane oxygenation or standard care in patients with cardiogenic shock complicating acute myocardial infarction: the multicentre, randomised EURO SHOCK trial. EuroIntervention 2023; 19:482–492. PubMed PMC

Thiele H, Zeymer U, Akin I, et al. . Extracorporeal life support in infarct-related cardiogenic shock. N Engl J Med 2023; 389:1286–1297. PubMed

Zeymer U, Freund A, Hochadel M, et al. . Venoarterial extracorporeal membrane oxygenation in patients with infarct-related cardiogenic shock: an individual patient data meta-analysis of randomised trials. Lancet 2023; 02:1338–1346. PubMed

Moller JE, Engstrom T, Jensen LO, et al. . Microaxial flow pump or standard care in infarct-related cardiogenic shock. N Engl J Med 2024; 390:1382–1393. PubMed

Vincent JL, De Backer D. Circulatory shock. N Engl J Med 2013; 369:1726–1734. PubMed

Zeymer U, Bueno H, Granger CB, et al. . Acute Cardiovascular Care Association position statement for the diagnosis and treatment of patients with acute myocardial infarction complicated by cardiogenic shock: a document of the Acute Cardiovascular Care Association of the European Society of Cardiology. Eur Heart J Acute Cardiovasc Care 2020; 9:183–197. PubMed

Chioncel O, Parissis J, Mebazaa A, et al. . Epidemiology, pathophysiology and contemporary management of cardiogenic shock – a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2020; 22:1315–1341. PubMed

Ostadal P, Belohlavek J. Response by Ostadal and Belohlavek to letter regarding article, “Extracorporeal membrane oxygenation in the therapy of cardiogenic shock: results of the ECMO-CS randomized clinical trial”. Circulation 2023; 148:804. PubMed

Byrne RA, Rossello X, Coughlan JJ, et al. . 2023 ESC guidelines for the management of acute coronary syndromes. Eur Heart J 2023; 44:3720–3826. PubMed

Jentzer JC, Tabi M, Burstein B. Managing the first 120 min of cardiogenic shock: from resuscitation to diagnosis. Curr Opin Crit Care 2021; 27:416–425. PubMed

Jentzer JC, Wiley BM, Anavekar NS, et al. . Noninvasive hemodynamic assessment of shock severity and mortality risk prediction in the cardiac intensive care unit. JACC Cardiovasc Imaging 2021; 14:321–332. PubMed

Evans L, Rhodes A, Alhazzani W, et al. . Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 2021; 47:1181–1247. PubMed PMC

Furer A, Wessler J, Burkhoff D. Hemodynamics of cardiogenic shock. Interv Cardiol Clin 2017; 6:359–371. PubMed

Vincent JL, Joosten A, Saugel B. Hemodynamic monitoring and support. Crit Care Med 2021; 49:1638–1650. PubMed

Flick M, Bergholz A, Sierzputowski P, et al. . What is new in hemodynamic monitoring and management? J Clin Monit Comput 2022; 36:305–313. PubMed PMC

Pinsky MR, Cecconi M, Chew MS, et al. . Effective hemodynamic monitoring. Crit Care 2022; 26:294. PubMed PMC

Garan AR, Kanwar M, Thayer KL, et al. . Complete hemodynamic profiling with pulmonary artery catheters in cardiogenic shock is associated with lower in-hospital mortality. JACC Heart Fail 2020; 8:903–913. PubMed

Monge Garcia MI, Santos Oviedo A. Why should we continue measuring central venous pressure? Med Intensiva 2017; 41:483–486. PubMed

Pinsky MR, Kellum JA, Bellomo R. Central venous pressure is a stopping rule, not a target of fluid resuscitation. Crit Care Resusc 2014; 16:245–246. PubMed

Magder S. Understanding central venous pressure: not a preload index? Curr Opin Crit Care 2015; 21:369–375. PubMed

Magder S. Right atrial pressure in the critically ill: how to measure, what is the value, what are the limitations? Chest 2017; 151:908–916. PubMed

Grand J, Kjaergaard J, Bro-Jeppesen J, et al. . Cardiac output, heart rate and stroke volume during targeted temperature management after out-of-hospital cardiac arrest: association with mortality and cause of death. Resuscitation 2019; 142:136–143. PubMed

Grand J, Wiberg S, Kjaergaard J, et al. . Increasing mean arterial pressure or cardiac output in comatose out-of-hospital cardiac arrest patients undergoing targeted temperature management: effects on cerebral tissue oxygenation and systemic hemodynamics. Resuscitation 2021; 168:199–205. PubMed

Grand J, Hassager C, Schmidt H, et al. . Serial assessments of cardiac output and mixed venous oxygen saturation in comatose patients after out-of-hospital cardiac arrest. Crit Care 2023; 27:410. PubMed PMC

Josiassen J, Lerche Helgestad OK, Moller JE, et al. . Hemodynamic and metabolic recovery in acute myocardial infarction-related cardiogenic shock is more rapid among patients presenting with out-of-hospital cardiac arrest. PLoS One 2020; 15:e0244294. PubMed PMC

Thiele H, Zeymer U, Neumann FJ, et al. . Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 2012; 367:1287–1296. PubMed

Bertini P, Guarracino F. Pathophysiology of cardiogenic shock. Curr Opin Crit Care 2021; 27:409–415. PubMed

De Backer D, Creteur J, Dubois MJ, et al. . Microvascular alterations in patients with acute severe heart failure and cardiogenic shock. Am Heart J 2004; 147:91–99. PubMed

Cardiac index, SvO2 or pCO2 gap may determine benefit from ECMO in cardiogenic shock: post-hoc analysis of the multicenter, randomized ECMO-CS trial