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Experts' recommendations for the management of adult patients with cardiogenic shock

Nadia Aissaoui1, Clement Delmas2, Hamid Merdji3

  • 1Intensive Cardiac Care Unit, Cardiology department, Hôpital européen Georges-Pompidou, Assistance publique des Hôpitaux de Paris, Université Paris Cité, Paris, France.

Archives of Cardiovascular Diseases
|March 24, 2026
PubMed

Insights

New European guidelines offer updated management strategies for cardiogenic shock (CS) in adults. These recommendations emphasize multidisciplinary teams, early etiological treatment, and appropriate hemodynamic support for improved patient outcomes.

Area of Science:

  • Cardiology
  • Intensive Care Medicine
  • Critical Care

Background:

  • European guidelines for cardiogenic shock (CS) management are over a decade old.
  • There is a need for updated, evidence-based recommendations for adult CS.
  • Multidisciplinary expert groups are essential for developing comprehensive guidelines.

Purpose of the Study:

  • To develop and present updated recommendations for the management of cardiogenic shock in adult patients.
  • To provide guidance on CS teams, medical and etiological management, organ support, and circulatory support.
  • To address the lack of recent specific international European guidelines.

Main Methods:

  • Utilized the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.
  • Developed by a joint expert group from French medical societies (SRLF, SFC, SFAR, SFCTCV).
  • Identified 23 PICO questions leading to 41 recommendations across six key areas.

Main Results:

  • Generated 41 recommendations for adult cardiogenic shock management.
  • Recommendations include 7 with high evidence, 11 with moderate, and 17 with low evidence (expert opinion).
  • Strong expert agreement achieved on all recommendations, highlighting the need for structured shock teams and early etiological treatment.

Conclusions:

  • Optimal cardiogenic shock management requires a structured, multidisciplinary approach and standardized protocols.
  • Early etiological treatment, such as revascularization or valve intervention, is crucial for improving outcomes.
  • Hemodynamic support should prioritize norepinephrine, with mechanical circulatory support reserved for selected cases.

Keywords:
Cardiogenic shockGuidelinesHeart teamTemporary circulatory support

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