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Review
. 2020 Aug;22(8):1315-1341.
doi: 10.1002/ejhf.1922. Epub 2020 Jul 16.

Epidemiology, pathophysiology and contemporary management of cardiogenic shock - a position statement from the Heart Failure Association of the European Society of Cardiology

Ovidiu Chioncel  1   2 , John Parissis  3   4 , Alexandre Mebazaa  5 , Holger Thiele  6   7 , Steffen Desch  6   7 , Johann Bauersachs  8 , Veli-Pekka Harjola  9 , Elena-Laura Antohi  1   2 , Mattia Arrigo  10 , Tuvia Ben Gal  11   12 , Jelena Celutkiene  13 , Sean P Collins  14 , Daniel DeBacker  15 , Vlad A Iliescu  1   2 , Ewa Jankowska  16 , Tiny Jaarsma  17   18 , Kalliopi Keramida  4   19 , Mitja Lainscak  20   21 , Lars H Lund  22   23 , Alexander R Lyon  24   25 , Josep Masip  26   27 , Marco Metra  28 , Oscar Miro  29   30 , Andrea Mortara  31 , Christian Mueller  32 , Wilfried Mullens  33   34 , Maria Nikolaou  3 , Massimo Piepoli  35 , Susana Price  36 , Giuseppe Rosano  37   38 , Antoine Vieillard-Baron  39   40 , Jean M Weinstein  41 , Stefan D Anker  42   43 , Gerasimos Filippatos  44   45 , Frank Ruschitzka  10 , Andrew J S Coats  46 , Petar Seferovic  47   48
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Free article
Review

Epidemiology, pathophysiology and contemporary management of cardiogenic shock - a position statement from the Heart Failure Association of the European Society of Cardiology

Ovidiu Chioncel et al. Eur J Heart Fail. 2020 Aug.
Free article

Erratum in

Abstract

Cardiogenic shock (CS) is a complex multifactorial clinical syndrome with extremely high mortality, developing as a continuum, and progressing from the initial insult (underlying cause) to the subsequent occurrence of organ failure and death. There is a large spectrum of CS presentations resulting from the interaction between an acute cardiac insult and a patient's underlying cardiac and overall medical condition. Phenotyping patients with CS may have clinical impact on management because classification would support initiation of appropriate therapies. CS management should consider appropriate organization of the health care services, and therapies must be given to the appropriately selected patients, in a timely manner, whilst avoiding iatrogenic harm. Although several consensus-driven algorithms have been proposed, CS management remains challenging and substantial investments in research and development have not yielded proof of efficacy and safety for most of the therapies tested, and outcome in this condition remains poor. Future studies should consider the identification of the new pathophysiological targets, and high-quality translational research should facilitate incorporation of more targeted interventions in clinical research protocols, aimed to improve individual patient outcomes. Designing outcome clinical trials in CS remains particularly challenging in this critical and very costly scenario in cardiology, but information from these trials is imperiously needed to better inform the guidelines and clinical practice. The goal of this review is to summarize the current knowledge concerning the definition, epidemiology, underlying causes, pathophysiology and management of CS based on important lessons from clinical trials and registries, with a focus on improving in-hospital management.

Keywords: Cardiogenic shock; Mechanical circulatory support; Multidisciplinary team; Organ dysfunction.

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References

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