Table 1.
Clinical phenotypes in cardiogenic shock. Adapted from van Diepen et al.5 CS: cardiogenic shock; SVR: systemic vascular resistance; CI: cardiac index; PCWP: pulmonary capillary wedge pressure
| VOLUME STATUS | |||
|---|---|---|---|
| WET | DRY | ||
| PERIPHERAL PERFUSION STATUS | Cold | Classic CS (“Cold & Wet”) High SVR, low CI, high PCWP | Euvolemic CS (“Cold & Dry”) High SVR, low CI, low/normal PCPW |
| Warm | Mixed CS (“Warm & Wet”) Normal SVR, low CI, high PCWP | Vasodilatory Shock (no CS) Low SVR, high CI, low PCWP | |
Table 2.
The Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile. Adapted from Stevenson et al.6 IV: intravenous; ADLs: activities of daily living
| PROFILE | TITLE | TAG NAME | DESCRIPTION |
|---|---|---|---|
| 1#* | Critical cardiogenic shock | “Crash and burn” | Life-threatening hypotension refractory to IV inotropes |
| 2#* | Progressive decline | “Sliding on inotropes” | IV inotropes required with worsening end-organ function |
| 3#* | Inotrope dependent | “Dependent stability” | Stable blood pressure and end-organ function but failure to wean from IV inotropes |
| 4*, § | Resting symptoms - home on oral therapy | Daily symptoms of congestion at rest or with ADLs and high doses of diuretics | |
| 5*, § | Exertion intolerant | Unable to engage in any activity above ADLs | |
| 6*, § | Exertion limited | “Walking wounded” | Can participate in minor activities but quickly fatigued |
| 7* | Advanced NYHA III | Comfortable with meaningful activity but limited to mild exertion |
Table 3.
The Society for Cardiovascular Angiography and Interventions classification of cardiogenic shock. Adapted from Baran et al.7 CS: cardiogenic shock; MI: myocardial infarction; CHF: congestive heart failure; MCS: mechanical circulatory support; CPR: cardiopulmonary resuscitation; ECPR: extracorporeal membrane oxygenation-facilitated CPR
| STAGE/NAME | DESCRIPTION |
|---|---|
| A “At Risk” | Patient is not currently experiencing signs or symptoms of CS but is at risk (ie, MI, CHF) |
| B “Beginning CS” | Patient has clinical evidence of relative hypotension without hypoperfusion |
| C “Classic CS” | Patient manifests with hypoperfusion that requires intervention (inotrope/pressor or MCS) beyond volume resuscitation to restore perfusion |
| D “Deteriorating/Doom” | Patient is similar to category C but is getting worse and failing to respond to initial interventions |
| E “Extremis” | Patient has circulatory collapse, frequent refractory cardiac arrest with ongoing CPR, or is being supported by multiple simultaneous acute interventions including ECPR |
[i] Modifier A: cardiac arrest—the presence of cardiac arrest, at any stage, would be considered a subtype (ie, BA, CA, DA, EA)