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Mixed Cardiogenic Shock: A Proposal for Standardized Classification, a Hemodynamic Definition, and Framework for

Sean van Diepen1, Janine Pöss2, Janek M Senaratne1

  • 1Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada (S.v.D., J.M.S.).

Circulation
|October 28, 2024
PubMed

Insights

Cardiogenic shock (CS) classification now recognizes mixed states beyond cold-and-wet profiles. This study proposes a new framework to better categorize and manage these complex CS presentations.

Area of Science:

  • Cardiology
  • Intensive Care Medicine
  • Hemodynamics

Background:

  • Cardiogenic shock (CS) classification has evolved beyond a single hemodynamic profile.
  • Contemporary data reveal significant variability in CS acuity, causes, volume status, and vascular resistance.
  • Mixed CS, defined as CS with at least one additional shock state, is the second leading cause of shock in intensive care units.

Purpose of the Study:

  • To summarize the current epidemiology of mixed cardiogenic shock.
  • To propose a novel classification framework for mixed CS.
  • To suggest invasive hemodynamic parameters for categorizing and managing mixed CS.

Main Methods:

  • Review of current literature and registry data on cardiogenic shock.
  • Analysis of hemodynamic profiles in patients with mixed CS states.
  • Development of a proposed classification system and diagnostic parameters.

Main Results:

  • Mixed CS states exhibit considerable heterogeneity in presentation and underlying factors.
  • Existing classification systems and evidence are insufficient for guiding mixed CS care.
  • A proposed framework aims to standardize phenotyping and management strategies.

Conclusions:

  • A refined understanding of CS acknowledges diverse presentations, including mixed shock states.
  • Standardized classification and hemodynamic definitions are crucial for advancing mixed CS research and clinical practice.
  • The proposed framework offers a pathway to better patient phenotyping and targeted management in mixed CS.

Keywords:
cardiogenic shockhypovolemic shockmixed shockvasodilatory shock

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