Review of Advancements in Managing Cardiogenic Shock: From Emergency Care Protocols to Long-Term Therapeutic Strategies

Abstract

Cardiogenic shock (CS) is a complex multifactorial clinical syndrome of end-organ hypoperfusion that could be associated with multisystem organ failure, presenting a diverse range of causes and symptoms. Despite improving survival in recent years due to new advancements, CS still carries a high risk of severe morbidity and mortality. Recent research has focused on improving early detection and understanding of CS through standardized team approaches, detailed hemodynamic assessment, and selective use of temporary mechanical circulatory support devices, leading to better patient outcomes. This review examines CS pathophysiology, emerging classifications, current drug and device therapies, standardized team management strategies, and regionalized care systems aimed at optimizing shock outcomes. Furthermore, we identify gaps in knowledge and outline future research needs.

Keywords: acute myocardial infarction; advanced heart failure; cardiac critical care; cardiogenic shock; mechanical circulatory support; shock team.

Figure 1

Pathophysiology of cardiogenic shock. Adapted from [1,2]. An abrupt drop in myocardial contractility produces myocardial dysfunction and a reduction in stroke volume. This leads to hypotension and decreased peripheral perfusion, triggering a reflex increase in cardiac and systemic vascular resistance, propagating myocardial ischemia. A vicious cycle of hypoperfusion, end-organ dysfunction, and inflammation occurs, ultimately leading to refractory hemometabolic shock and death.

Figure 2

SCAI classification and definition of each stage. Adapted from [21,22]. BNP, B-type natriuretic peptide; CPR, cardiopulmonary resuscitation; CVP, central venous pressure; GFR, glomerular filtration rate; JVP, jugular venous pressure; LFT, liver function test; MAP, mean arterial pressure; MCS, mechanical circulatory support; PA, pulmonary artery; PCWP, pulmonary capillary wedge pressure; SBP, systolic blood pressure.

Figure 3

Global approach to CS. Early detection, differential diagnosis, and risk stratification. Adapted from [28]. AMI-CS, cardiogenic shock complicating acute myocardial infarction; CS, cardiogenic shock; DO₂, oxygen delivery; HF-CS, heart-failure-related CS; LVAD, left ventricular assist device; MAP, mean arterial pressure; MCS, mechanical circulatory support; RV, right ventricle.

Figure 4

Shock team multidisciplinary approach.

Figure 5

Organization of regional cardiogenic shock networks. Adapted from [123]. AMI, acute myocardial infarction; CS, cardiogenic shock; CVS, cardiovascular surgery; HF, heart failure; HT, heart transplant; ICU, intensive care unit; MCS, mechanical circulatory support; PCI, percutaneous coronary intervention; S, surgery; VA, mid/long-term ventricular assistance; VA-ECMO, venoarterial extracorporeal membrane oxygenation.