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.

• Keywords
• cardiogenic shock, heart transplantation, hemodynamics, inotropes, left ventricular assist devices, mechanical circulatory support,
• MeSH
• Hemodynamics * physiology   MeSH
• Intensive Care Units * MeSH
• Shock, Cardiogenic * therapy   physiopathology   MeSH
• Humans MeSH
• Heart-Assist Devices MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

There has been a significant increase in the use of short-term percutaneous ventricular assist devices (pVADs) as acute circulatory support in cardiogenic shock and to provide haemodynamic support during interventional procedures, including high-risk percutaneous coronary interventions. Although frequently considered together, pVADs differ in their haemodynamic effects, management, indications, insertion techniques, and monitoring requirements. This consensus document summarizes the views of an expert panel by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) and the Association for Acute Cardiovascular Care (ACVC) and appraises the value of short-term pVAD. It reviews the pathophysiological context and possible indications for pVAD in different clinical settings and provides guidance regarding the management of pVAD based on existing evidence and best current practice.

• Keywords
• Acute coronary syndromes, ECMO, High-risk percutaneous coronary intervention, Impella, Intra-aortic balloon pump, Mechanical circulatory support,
• MeSH
• Hemodynamics MeSH
• Intra-Aortic Balloon Pumping MeSH
• Shock, Cardiogenic therapy   MeSH
• Consensus MeSH
• Percutaneous Coronary Intervention * MeSH
• Humans MeSH
• Heart-Assist Devices * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH