Sandbox: Cardiogenic Shock

Template:Cardiogenic Shock - 2017 Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1],Associate Editor(s)-in-Chief: Arzu Kalayci, M.D. [2]

Contemporary Management of Cariogenic Shock

Pragmatic and Clinical Trial Definitions of Cardiogenic Shock

Clinical Definition	SHOCK Trial	IABP-SHOCK II	ESC HF Guidelines
Cardiac disorder that results in both clinical and biochemical evidence of tissue hypoperfusion	Clinical criteria: SBP <90 mmHg for ≥30 min OR Support to maintain SBP ≥90 mmHg AND End-organ hypoperfusion (urine output <30 mL/h or cool extremities) Hemodynamic criteria: CI of ≤2.2 L·min−1·m−2 AND PCWP ≥15 mmHg	Clinical criteria: SBP <90 mmHg for ≥30 min OR Catecholamines to maintain SBP >90 mmHg AND Clinical pulmonary congestion AND Impaired end-organ perfusion (altered mental status, cold/clammy skin and extremities, urine output <30 mL/h, or lactate >2.0 mmol/L)	SBP <90 mmHg with adequate volume and clinical or laboratory signs of hypoperfusion Clinical hypoperfusion: Cold extremities, oliguria, mental confusion, dizziness, narrow pulse pressure Laboratory hypoperfusion: Metabolic acidosis, elevated serum lactate, elevated serum creatinine
CI indicates cardiac index; CS, cardiogenic shock; ESC, European Society of Cardiology; HF, heart failure; IABP-SHOCK II, Intraaortic Balloon Pump in Cardiogenic Shock II; LV, left ventricular; MI, myocardial infarction; PCWP, pulmonary capillary wedge pressure; SBP, systolic blood pressure; and SHOCK, Should We Emergently Revascularize Occluded Coronaries for Cariogenic Shock

Potential Hemodynamic Presentations of Cardiogenic Shock

Volume Status
Peripheral Circulation	Cold	Classic Cardiogenic Shock or Mixed Shock (↓Cl; ↑SVRI; ↑PCWP)	Euvolemic Cardiogenic Shock (↓Cl; ↑SVRI;↔PCWP)
	Warm	Vasodilatory Cardiogenic Shock or Mixed Shock (↓Cl; ↓/↔SVRI;↑PCWP)	Vasodilatory Shock (Not Cardiogenic Shock) (↑Cl; ↓SVRI; ↓PCWP)
CI indicates cardiac index; PCWP, pulmonary capillary wedge pressure; and SVRI, systemic vascular resistance index.