David A Baran1, Cindy L Grines2, Steven Bailey3, Daniel Burkhoff4, Shelley A Hall5, Timothy D Henry6, Steven M Hollenberg7, Navin K Kapur8, William O'Neill9, Joseph P Ornato10, Kelly Stelling1, Holger Thiele11, Sean van Diepen12, Srihari S Naidu13. 1. Sentara Heart Hospital, Division of Cardiology, Advanced Heart Failure Center and Eastern Virginia Medical School, Norfolk, Virginia. 2. Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, New York. 3. Department of Internal Medicine, LSU Health School of Medicine, Shreveport, Louisiana. 4. Cardiovascular Research Foundation, New York City, New York. 5. Baylor University Medical Center, Dallas, Texas. 6. Lindner Research Center at the Christ Hospital, Cincinnati, Ohio. 7. Cooper University Hospital, Camden, New Jersey. 8. The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts. 9. Henry Ford Health System, Detroit, Michigan. 10. Virginia Commonwealth University Health System, Richmond, Virginia. 11. Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany. 12. Department of Critical Care Medicine and Division of Cardiology, University of Alberta, Edmonton, Canada. 13. Westchester Medical Center and New York Medical College, Valhalla, New York.
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.
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.
Authors: Manal Alasnag; Alexander G Truesdell; Holli Williams; Sara C Martinez; Syeda Kashfi Qadri; John P Skendelas; William A Jakobleff; Mirvat Alasnag Journal: Curr Atheroscler Rep Date: 2020-04-23 Impact factor: 5.113
Authors: David D Berg; Christopher F Barnett; Benjamin B Kenigsberg; Alexander Papolos; Carlos L Alviar; Vivian M Baird-Zars; Gregory W Barsness; Erin A Bohula; Joseph Brennan; James A Burke; Anthony P Carnicelli; Sunit-Preet Chaudhry; Paul C Cremer; Lori B Daniels; Andrew P DeFilippis; Daniel A Gerber; Christopher B Granger; Steven Hollenberg; James M Horowitz; James D Gladden; Jason N Katz; Ellen C Keeley; Norma Keller; Michael C Kontos; Patrick R Lawler; Venu Menon; Thomas S Metkus; P Elliott Miller; Jose Nativi-Nicolau; L Kristin Newby; Jeong-Gun Park; Nicholas Phreaner; Robert O Roswell; Steven P Schulman; Shashank S Sinha; R Jeffrey Snell; Michael A Solomon; Jeffrey J Teuteberg; Wayne Tymchak; Sean van Diepen; David A Morrow Journal: Circ Heart Fail Date: 2019-11-11 Impact factor: 8.790
Authors: Behnam N Tehrani; Alexander G Truesdell; Mitchell A Psotka; Carolyn Rosner; Ramesh Singh; Shashank S Sinha; Abdulla A Damluji; Wayne B Batchelor Journal: JACC Heart Fail Date: 2020-11 Impact factor: 12.035
Authors: Fabiana G Marcondes-Braga; Lídia Ana Zytynski Moura; Victor Sarli Issa; Jefferson Luis Vieira; Luis Eduardo Rohde; Marcus Vinícius Simões; Miguel Morita Fernandes-Silva; Salvador Rassi; Silvia Marinho Martins Alves; Denilson Campos de Albuquerque; Dirceu Rodrigues de Almeida; Edimar Alcides Bocchi; Felix José Alvarez Ramires; Fernando Bacal; João Manoel Rossi Neto; Luiz Claudio Danzmann; Marcelo Westerlund Montera; Mucio Tavares de Oliveira Junior; Nadine Clausell; Odilson Marcos Silvestre; Reinaldo Bulgarelli Bestetti; Sabrina Bernadez-Pereira; Aguinaldo F Freitas; Andréia Biolo; Antonio Carlos Pereira Barretto; Antônio José Lagoeiro Jorge; Bruno Biselli; Carlos Eduardo Lucena Montenegro; Edval Gomes Dos Santos Júnior; Estêvão Lanna Figueiredo; Fábio Fernandes; Fabio Serra Silveira; Fernando Antibas Atik; Flávio de Souza Brito; Germano Emílio Conceição Souza; Gustavo Calado de Aguiar Ribeiro; Humberto Villacorta; João David de Souza Neto; Livia Adams Goldraich; Luís Beck-da-Silva; Manoel Fernandes Canesin; Marcelo Imbroinise Bittencourt; Marcely Gimenes Bonatto; Maria da Consolação Vieira Moreira; Mônica Samuel Avila; Otavio Rizzi Coelho Filho; Pedro Vellosa Schwartzmann; Ricardo Mourilhe-Rocha; Sandrigo Mangini; Silvia Moreira Ayub Ferreira; José Albuquerque de Figueiredo Neto; Evandro Tinoco Mesquita Journal: Arq Bras Cardiol Date: 2021-06 Impact factor: 2.000