Current perspectives in cardiogenic shock

Cardiogenic shock (CS) remains a leading cause of death in intensive cardiac care. Outcomes are limited by delayed recognition of hypoperfusion, heterogeneous phenotypes, and late escalation of therapies. Diagnosis and risk stratification have progressed with the introduction of the SCAI staging system, which provides a common language for clinical severity and guides escalation of care. Echocardiography and invasive hemodynamics remain central for defining ventricular phenotype, detecting mechanical complications, and tailoring therapy. Early activation of multidisciplinary shock teams is increasingly adopted to coordinate rapid assessment and structured management. Treatment focuses on restoring perfusion, correcting the underlying cause, and preventing further organ injury. Norepinephrine is generally preferred as first-line vasopressor, while inotropes, including dobutamine and milrinone, are selected according to physiologic profile rather than theoretical advantages. Mechanical circulatory support (MCS) should be considered early in refractory hypoperfusion, using integrated clinical, metabolic, echocardiographic, and PAC-derived triggers when feasible. Multiorgan support (ventilation, renal replacement therapy, and ECMO-related strategies such as LV unloading/venting) should be aligned with shock trajectory and goals of care. CS management should shift from a "one-size-fits-all" model to an early, phenotype-driven strategy with explicit perfusion targets and timely MCS escalation, supported by shock teams and networks. Emerging biomarkers and machine-learning tools may further improve risk stratification and treatment timing.