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Review
. 2024 Nov 16;404(10466):2006-2020.
doi: 10.1016/S0140-6736(24)01818-X.

Cardiogenic shock

Enzo Lüsebrink  1 , Leonhard Binzenhöfer  1 , Marianna Adamo  2 , Roberto Lorusso  3 , Alexandre Mebazaa  4 , David A Morrow  5 , Susanna Price  6 , Jacob C Jentzer  7 , Daniel Brodie  8 , Alain Combes  9 , Holger Thiele  10
Affiliations
Free article
Review

Cardiogenic shock

Enzo Lüsebrink et al. Lancet. .
Free article

Abstract

Cardiogenic shock is a complex syndrome defined by systemic hypoperfusion and inadequate cardiac output arising from a wide array of underlying causes. Although the understanding of cardiogenic shock epidemiology, specific subphenotypes, haemodynamics, and cardiogenic shock severity staging has evolved, few therapeutic interventions have shown survival benefit. Results from seminal randomised controlled trials support early revascularisation of the culprit vessel in infarct-related cardiogenic shock and provide evidence of improved survival with the use of temporary circulatory support in selected patients. However, numerous questions remain unanswered, including optimal pharmacotherapy regimens, the role of mechanical circulatory support devices, management of secondary organ dysfunction, and best supportive care. This Review summarises current definitions, pathophysiological principles, and management approaches in cardiogenic shock, and highlights key knowledge gaps to advance individualised shock therapy and the evidence-based ethical use of modern technology and resources in cardiogenic shock.

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Conflict of interest statement

Declaration of interests MA reports speaker honoraria from Abbott Vascular and Edwards Lifesciences, unrelated to the submitted work. RL reports research grants from Medtronic and LivaNova paid to their institution; consulting fees from Medtronic and LivaNova paid to their institution; speaker honoraria from Abiomed; travel support from Medtronic and LivaNova; lab supplies from Medtronic, unrelated to the submitted work; and is an advisory board member for Eurosets and Xenios (fees paid to institution). AM reports research grants from Roche, 4TEEN4, Sphyngotec, Abbott Diagnostics, and Windtree; consulting fees from Roche, Adrenomed, Corteria, and Fire1; speaker honoraria from Merck, Novartis, Roche, and Bayer; and lab supplies by Sphyngotec, unrelated to the submitted work; and is an advisory board member for Secret-HF, S-Form Pharma, and Implicity. DAM reports research grants from Abbott Laboratories, Abiomed, Amgen, Anthos Therapeutics, Arca Biopharma, AstraZeneca, Daiichi Sankyo, Intarcia, Janssen, Merck & Co, Novartis, Pfizer, Poxel, Regeneron, Roche Diagnostics, Siemens, Softcell Medical, and Zora Biosciences (paid to the institution); consulting fees from Abbott Laboratories, Arca Biopharma, Merck & Co, Novartis, Regeneron, and Roche Diagnostics unrelated to the submitted work; and is an advisory board member for InCarda Therapeutics. DB reports a research grant from LivaNova paid to their institution; consulting fees from LivaNova, Xenios, Medtronic, Inspira, Cellenkos, and HBOX Therapies; and payment from UpToDate, unrelated to the submitted work. AC reports speaker honoraria from Getinge, Baxter, and Xenios unrelated to the submitted work. All other authors declare no competing interests.

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