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Cardiogenic Shock Management (ESC 2021 + SCAI)

Cardiogenic Shock Management (ESC 2021 + SCAI): Cardiogenic Shock → SCAI Staging → Initial Management → IABP NOT Recommended.

Pathway Overview

10 steps

Algorithm Steps

10 total

  1. 01Start

    Cardiogenic Shock

    Hypoperfusion despite adequate filling

    • SBP <90 or MAP <65
    • Signs of hypoperfusion
    • Elevated filling pressures
  2. 02Action

    SCAI Staging

    Classify shock severity

    • A: At Risk
    • B: Beginning (hypotension)
    • C: Classic (hypoperfusion)
    • D: Deteriorating
    • E: Extremis
  3. 03Action

    Initial Management

    Volume assessment + vasoactives

    • Fluid challenge if no congestion
    • Norepinephrine: First-line pressor (IIa)
    • Dobutamine: If low cardiac output
  4. 04Warning

    IABP NOT Recommended

    Class III for AMI-CS

    • Based on IABP-SHOCK II trial
    • No mortality benefit
  5. 05Decision

    Refractory? MCS Needed?

    Lactate rising, deteriorating

  6. If Yes
    1. 06Action

      Impella (Class IIa)

      LV support device

      • SCAI B-C: Impella CP (2.5-4.0 L/min)
      • SCAI C-D: Impella 5.5 (5.0 L/min)
      • Lactate >7.8: May need ECLS
    2. 07Decision

      Lactate Clearing?

      Monitor response

    3. If Yes
      1. 08Outcome

        Recovery - Wean Support

        Gradual device weaning

      If No
      1. 09Outcome

        Advanced HF Therapy

        LVAD or transplant evaluation

    4. 10Action

      VA-ECMO

      Biventricular support

      • SCAI D-E / Extremis / CPR
      • RV failure (Impella is LV-only)
      • Bridge to decision/recovery/transplant
    5. Path rejoins step 07Shared downstream outcome
    If No

    No branch defined.

Guideline Source

ESC 2021 HF Guidelines + SCAI Shock Classification

DOI: 10.1093/eurheartj/ehab368View Guideline

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

pediatric

Applicable Regions

EUUS

EU: ESC guidelines + SCAI staging

US: SCAI classification widely adopted

Version 1Next review: 2027-08-01

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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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