Cardiogenic Shock Management (ESC 2021 + SCAI)
Cardiogenic Shock Management (ESC 2021 + SCAI): Cardiogenic Shock → SCAI Staging → Initial Management → IABP NOT Recommended.
Interactive Decision Tree
Algorithm Steps
- ▶Start
Cardiogenic Shock
Hypoperfusion despite adequate filling
- SBP <90 or MAP <65
- Signs of hypoperfusion
- Elevated filling pressures
- ●Action
SCAI Staging
Classify shock severity
- A: At Risk
- B: Beginning (hypotension)
- C: Classic (hypoperfusion)
- D: Deteriorating
- E: Extremis
- ●Action
Initial Management
Volume assessment + vasoactives
- Fluid challenge if no congestion
- Norepinephrine: First-line pressor (IIa)
- Dobutamine: If low cardiac output
- ⚠Warning
IABP NOT Recommended
Class III for AMI-CS
- Based on IABP-SHOCK II trial
- No mortality benefit
- ◆Decision
Refractory? MCS Needed?
Lactate rising, deteriorating
If Yes:
- ●Action
VA-ECMO
Biventricular support
- SCAI D-E / Extremis / CPR
- RV failure (Impella is LV-only)
- Bridge to decision/recovery/transplant
Guideline Source
ESC 2021 HF Guidelines + SCAI Shock Classification
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Drug dosing simplified
- MCS device selection depends on local expertise
- Does not replace shock team consultation
Contraindicated Populations
Applicable Regions
EU: ESC guidelines + SCAI staging
US: SCAI classification widely adopted
Next steps
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Related Resources
Frequently Asked Questions
What is the Cardiogenic Shock Management (ESC 2021 + SCAI)?
The Cardiogenic Shock Management (ESC 2021 + SCAI) is a emergency clinical algorithm for Cardiology. It provides a structured decision tree to guide clinical decision-making, based on ESC 2021 HF Guidelines + SCAI Shock Classification.
What guideline is the Cardiogenic Shock Management (ESC 2021 + SCAI) based on?
This algorithm is based on ESC 2021 HF Guidelines + SCAI Shock Classification (DOI: 10.1093/eurheartj/ehab368).
What are the limitations of the Cardiogenic Shock Management (ESC 2021 + SCAI)?
Known limitations include: Drug dosing simplified; MCS device selection depends on local expertise; Does not replace shock team consultation. Individual patient factors may require deviation from these recommendations.
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