Cardiogenic shock (CS) is a life-threatening condition that occurs when the heart cannot pump enough blood and oxygen to the brain and other critical organs. While all CS patients experience low cardiac output and resulting end-organ hypoperfusion, data from registries and clinical trials reveal considerable variation in severity, underlying causes, volume status, and systemic vascular resistance, leading to a more nuanced understanding of this complex condition.
Mixed CS, characterized by the presence of CS alongside at least one other shock state, is the second most common form of shock in contemporary coronary intensive care units and is linked to higher in-hospital mortality than pure CS. Despite the prevalence of mixed CS, standardized classifications, clear hemodynamic definitions, and high-quality evidence to guide routine treatment are still lacking.
Led by Dr. Sean van Diepen, this review examines the latest epidemiological data and proposes a classification framework and invasive hemodynamic parameters for improved patient categorization. The proposed classification system categorizes mixed CS based on the primary cause of shock: primarily cardiogenic (heart-related) with secondary cause of shock, or primarily non-cardiogenic (other causes) with secondary CS. The researchers also outline a simplified hemodynamic approach, using invasive hemodynamic parameters, to help identify secondary shock types in patients with primary CS or vasodilatory shock. The potential hemodynamic complexities of mixed CS often require invasive monitoring, individualized medical therapy, and careful assessment of the risks and benefits of temporary mechanical circulatory support. These recommendations provide practical guidance for optimizing management strategies and potentially improving patient outcomes.
