Patient handout

Cardiogenic shock (SCAI A–E)

PRODUCTION

1. Your condition

This handout is for cardiogenic shock (scai a–e). Your care team identified this based on: persistent sbp <90 / map <65 unresponsive to fluids (scai 2019 stage c criteria, baran et al).

Other reasons your team may use this plan: lactate ≥2.0 with cardiac failure (scai 2019 hypoperfusion marker, baran et al); severely reduced lvef on echo with hypoperfusion (acc/aha 2022 hf guideline); cool mottled extremities + aki / encephalopathy (scai 2019 end-organ hypoperfusion, baran et al).

3. When to call your provider

Contact your care team if any of the following happen:

Weight gain ≥3 lb in 24 h or ≥5 lb in 1 week → diuretic titration per protocol or ED (ACC/AHA 2022)
Symptomatic hypotension after ARNI up-titration → hold next dose, recheck in 1 week
K rising >5.5 → hold MRA first, consider K binder
Recurrent shock symptoms (orthostasis + AMS + oliguria) → ED + MCS-capable hub (SCAI 2022)
NYHA worsening to III+ → expedite cardiology re-evaluation (ACC/AHA 2022 Class I)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Lactate rising on max NE + dobutamine OR cardiac arrest (SCAI 2019 Stage D/E, Baran et al)(life-threatening)
CS within 24 h of STEMI / NSTE-ACS (SHOCK trial, Hochman NEJM 1999)(life-threatening)
Acute MR / VSR / free-wall rupture causing shock (ACC/AHA 2022)(life-threatening)
Severe RV failure (massive PE, RV infarct, ARDS) with shock (ESC 2021)(life-threatening)
Recurrent VT/VF despite amiodarone in CS (AHA ACLS 2020)(life-threatening)
AKI + hepatic dysfunction + AMS + coagulopathy in established CS (SCAI 2022 Stage D/E)(life-threatening)
Major bleeding or device thrombosis on Impella / VA-ECMO — DanGer Shock major bleed 21.8%, limb ischemia 5.6% (Møller NEJM 2024 PMID 38587239)
New / worsening RV failure on LV-only MCS — RV-LV mismatch on biventricular MCS or LV unloading reveals RV failure(life-threatening)
Lactate non-clearance after 24 h on max MCS + pressors + inotropes + multi-organ failure + age + frailty + SOFA trajectory worsening(life-threatening)

6. Sources

Guideline: SCAI Cardiogenic Shock Classification 2022 (Naidu JACC 2022, PMID 35115207) + AHA Cardiogenic Shock Scientific Statement 2017 (van Diepen Circulation 2017, PMID 28923988) + 2022 AHA/ACC/HFSA HF Guideline (Heidenreich Circulation 2022, PMID 35363499) + ESC HF Guideline 2021 (McDonagh EHJ 2021, PMID 34447992)