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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
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A Proposed Algorithm for the Management of Patients with Cardiogenic Shock Based on Contemporary Knowledge and Gaps

Aidonis Rammos1, Christos D Floros1, Ioannis Tzourtzos1

  • 1Second Department of Cardiology, University Hospital of Ioannina, 45500 Ioannina, Greece.

Journal of Cardiovascular Development and Disease
|December 24, 2025
PubMed

Insights

Cardiogenic shock (CS) management requires improved evidence for intravenous therapies and mechanical circulatory support (MCS). A proposed algorithm highlights gaps, emphasizing early diagnosis and organized care to improve patient outcomes.

Area of Science:

  • Cardiology
  • Critical Care Medicine

Background:

  • Cardiogenic shock (CS) presents a significant challenge with high mortality, even with advanced cardiac intensive care units (CICUs).
  • Current therapeutic strategies rely on intravenous (i.v.) pressors and mechanical circulatory support (MCS) devices, guided by CS profile, etiology, and SCAI stage.
  • Significant evidence gaps and controversies exist regarding optimal i.v. medications and MCS device utilization, compounded by variable availability and center experience.

Purpose of the Study:

  • To propose an evidence-based algorithm for cardiogenic shock (CS) management.
  • To identify and delineate critical gaps in the current therapeutic approaches for CS.
  • To suggest strategies for bridging therapeutic disparities and improving CS outcomes.

Main Methods:

  • This review synthesizes existing literature and clinical guidelines on cardiogenic shock (CS) management.
  • An algorithm for CS management is developed, detailing therapeutic steps and decision points.
  • Gaps in evidence and clinical practice at each stage of the proposed algorithm are identified.

Main Results:

  • The proposed algorithm outlines a structured approach to CS management, incorporating i.v. therapies and mechanical circulatory support (MCS).
  • Key evidence gaps were identified concerning the efficacy and selection of specific i.v. medications and MCS devices.
  • Disparities in device availability and institutional experience were noted as significant challenges.

Conclusions:

  • Addressing the identified evidence gaps through large-scale trials is crucial for optimizing CS treatment.
  • Enhanced health system organization, including the establishment of specialized shock centers, is recommended.
  • Early clinical suspicion, prompt diagnosis, and standardized management protocols are essential to improve outcomes in cardiogenic shock (CS).

Keywords:
acute myocardial infarctioncardiogenic shockheart failuremechanical circulatory supportmortality

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