In this post, I link to and excerpt from SCAI clinical expert consensus statement on the classification of cardiogenic shock [PubMed Abstract] [Full-Text HTML] [Full-Text PDF]. Catheter Cardiovasc Interv. 2019 Jul 1;94(1):29-37.
All that follows is from the above.
Abstract
Background: The outcome of cardiogenic shock complicating myocardial infarction has not appreciably changed in the last 30 years despite the development of various percutaneous mechanical circulatory support options. It is clear that there are varying degrees of cardiogenic shock but there is no robust classification scheme to categorize this disease state.
Methods: A multidisciplinary group of experts convened by the Society for Cardiovascular Angiography and Interventions was assembled to derive a proposed classification schema for cardiogenic shock. Representatives from cardiology (interventional, advanced heart failure, noninvasive), emergency medicine, critical care, and cardiac nursing all collaborated to develop the proposed schema.
Results: A system describing stages of cardiogenic shock from A to E was developed.
Stage A is “at risk” for cardiogenic shock, stage B is “beginning” shock, stage C is
“classic” cardiogenic shock, stage D is “deteriorating”, and E is “extremis”. The difference between stages B and C is the presence of hypoperfusion which is present in
stages C and higher. Stage D implies that the initial set of interventions chosen have not restored stability and adequate perfusion despite at least 30 minutes of observation and stage E is the patient in extremis, highly unstable, often with cardiovascular collapse.
Conclusion: This proposed classification system is simple, clinically applicable across the care spectrum from pre-hospital providers to intensive care staff but will require future validation studies to assess its utility and potential prognostic implications.KEYWORDS
cardiogenic shock, heart failure, hemodynamicsfig1
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6 | CONCLUSION
Despite intense study, the mortality of CS in association with MI remains approximately 50% even with the development of percutaneous mechanical circulatory support devices. It is likely that prior trials have not been successful partially because some patients were “too sick” to benefit from the studied intervention. Others may do well with or without an intervention, and in the absence of a standardized classification system, it may be impossible to ascertain which groups may benefit. The schema outlined is a result of a broad multidisciplinary collaboration of
experts to define the groups of patients who suffer from CS. The criteria are simple and clinically based, and if validated, this classification may become the “lingua franca” for the field. By having a common language, we hope to support communication at the bedside, in the catheterization laboratory, at the level of shock teams across institutions, and with clinical trialists as new approaches are tested to reduce the high mortality of CS.
