Related Experiment Video
Updated: Jul 4, 2025
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Clinical Presentation, Classification, and Outcomes of Cardiogenic Shock in Children
Kriti Puri1, Jacob C Jentzer2, Joseph A Spinner3
1Lillie Frank Abercrombie Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA; Division of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
Insights
Cardiogenic shock (CS) affects 26% of pediatric acute decompensated heart failure hospitalizations, increasing mortality risk. A new CS severity scale effectively predicts inpatient mortality in children.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
- Heart Failure Research
Background:
- Limited data exists on pediatric cardiogenic shock (CS) epidemiology and outcomes.
- Research on CS in adults is growing, but children remain understudied.
Purpose of the Study:
- To describe the epidemiology, clinical presentation, and outcomes of pediatric CS.
- To identify risk factors for CS and in-hospital mortality in children with acute decompensated heart failure (ADHF).
- To develop and validate a CS severity classification for pediatric patients.
Main Methods:
- Retrospective cohort study of ADHF hospitalizations in patients under 21 years old.
- Analysis of patients with CS at presentation, including risk factors and outcomes.
- Development of a modified Society for Cardiovascular Angiography and Interventions (SCAI) shock classification and staging.
Main Results:
- CS occurred in 26% of pediatric ADHF hospitalizations (n=207/803).
- CS was associated with worse systolic function, higher BNP, and increased renal/liver injury.
- Children with CS had higher in-hospital mortality (28% vs 11%) and required more mechanical ventilation and circulatory support.
- Each increase in CS stage correlated with greater inpatient mortality.
Conclusions:
- CS is a significant complication in pediatric ADHF, occurring in 26% of cases.
- CS is an independent predictor of hospital mortality in children.
- The modified SCAI classification effectively predicts increasing mortality risk in pediatric CS.
Background:
Despite growing cardiogenic shock (CS) research in adults, the epidemiology, clinical features, and outcomes of children with CS are lacking.
Objectives:
This study sought to describe the epidemiology, clinical presentation, hospital course, risk factors, and outcomes of CS among children hospitalized for acute decompensated heart failure (ADHF).
Methods:
We examined consecutive ADHF hospitalizations (<21 years of age) from a large single-center retrospective cohort. Patients with CS at presentation were analyzed and risk factors for CS and for the primary outcome of in-hospital mortality were identified. A modified Society for Cardiovascular Angiography and Interventions shock classification was created and patients were staged accordingly.
Results:
A total of 803 hospitalizations for ADHF were identified in 591 unique patients (median age 7.6 years). CS occurred in 207 (26%) hospitalizations. ADHF hospitalizations with CS were characterized by worse systolic function (P = 0.040), higher B-type natriuretic peptide concentration (P = 0.032), and more frequent early severe renal (P = 0.023) and liver (P < 0.001) injury than those without CS. Children presenting in CS received mechanical ventilation (87% vs 26%) and mechanical circulatory support (45% vs 16%) more frequently (both P < 0.001). Analyzing only the most recent ADHF hospitalization, children with CS were at increased risk of in-hospital mortality compared with children without CS (28% vs 11%; OR: 1.91; 95% CI: 1.05-3.45; P = 0.033). Each higher CS stage was associated with greater inpatient mortality (OR: 2.40-8.90; all P < 0.001).
Conclusions:
CS occurs in 26% of pediatric hospitalizations for ADHF and is independently associated with hospital mortality. A modified Society for Cardiovascular Angiography and Interventions classification for CS severity showed robust association with increasing mortality.
Related Concept Videos
01:24Blood Pressure Imbalances and Circulatory Shock
Blood Pressure: Hypertension and Hypotension
Normal blood pressure is 120/80 mm Hg. Elevated blood pressure is 120-129/under 80 mm Hg. Hypertension, warranting treatment at 130/80 mm Hg, is often asymptomatic and can lead to severe cardiovascular events, aneurysms, peripheral arterial disease, chronic renal disease, or cardiac...
01:17Pathophysiology of Heart Failure
01:18Cardiovascular Drugs: Classification based on Therapeutic Indications
01:29Pathophysiology of Cardiac Performance
01:28Mechanism of Cardiac Arrhythmias
01:26Imbalances in Cardiac Output
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...