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Definition, Classification, and Management of Primary Noncardiac Causes of Cardiogenic Shock
Tiffany Yuen1, Janek M Senaratne1
1Division of Cardiology, Department of Medicine, and the Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada.
Insights
This review proposes a new classification for cardiogenic shock (CS) that includes primary noncardiac causes. Recognizing these distinct etiologies can improve diagnosis, management, and outcomes for patients with this critical condition.
Area of Science:
- Cardiology
- Critical Care Medicine
- Pathophysiology
Background:
- Cardiogenic shock (CS) is a life-threatening condition characterized by inadequate cardiac output to perfuse organs.
- Current classifications primarily focus on cardiac etiologies, neglecting noncardiac causes.
- This gap hinders accurate diagnosis and effective management of CS originating from noncardiac origins.
Purpose of the Study:
- To propose a novel classification framework for cardiogenic shock that incorporates primary noncardiac etiologies.
- To categorize noncardiac causes of CS based on underlying disease mechanisms.
- To guide improved diagnosis, management, and clinical research for CS.
Main Methods:
- Review of existing literature on cardiogenic shock and its etiologies.
- Development of a classification system building upon the Shock Academic Research Consortium (SARC) framework.
- Categorization of noncardiac causes by disease mechanism: vascular, infectious, inflammatory, traumatic, toxic, cancer-related, endocrine, and metabolic.
Main Results:
- Identified primary noncardiac causes as a distinct and underrepresented category in CS classification.
- Proposed a structured framework to classify these noncardiac etiologies.
- Outlined management strategies for various noncardiac causes of CS.
Conclusions:
- A new classification recognizing primary noncardiac causes of CS is essential.
- This framework facilitates early identification and targeted treatment of noncardiac insults.
- Improved classification can enhance patient outcomes and aid clinical trial design in CS research.
Abstract:
Cardiogenic shock (CS) is a complex syndrome, presenting with a critical state of cardiac output insufficient to support end-organ perfusion requirements. Contemporary CS classification recognizes broad categories of primary cardiac etiologies of CS, such as acute myocardial infarction and heart failure. Primary noncardiac etiologies of CS, however, are poorly described in literature and have not been captured by any contemporary classification, leading to challenges in diagnosing and managing these cases. In this review, we propose that primary noncardiac causes of CS be recognized as its own category that builds on the original Shock Academic Research Consortium classification with its own additional modifiers. We present a detailed framework that groups each noncardiac cause by its underlying disease mechanism (vascular, infectious, inflammatory, traumatic, toxic, cancer related, endocrine, metabolic) and review available literature on their respective management strategies. We expect that the ability to classify primary noncardiac causes of CS will help with early identification and targeted management of the primary noncardiac insult, support patients through their shock state, and may lead to improvement of in-hospital CS mortality rates in clinical practice. Moreover, this new framework can further assist clinical trial classifications to properly phenotype CS for clinical research purposes.
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