Cardiogenic Shock and the Role of Critical Care Cardiology: Evidence, Models of Care, and Future Directions

The population found in today's cardiac intensive care unit (CICU) is strikingly different from that found in traditional coronary care units from decades ago, with increasing illness severity and higher prevalence of noncardiac critical illness. Cardiogenic shock (CS) is a heterogeneous syndrome commonly found in modern CICU with a variety of etiologies and presentations; despite advances in noninvasive monitoring and hemodynamic support, as well as efforts to standardize early identification and delivery of therapy, outcomes remain relatively poor. The establishment of critical care cardiology (CCC) as a distinct subspecialty was intended to address the acute needs of the patients in modern CICU, combining cardiovascular medicine expertise with the knowledge and skillset of a critical care intensivist to manage the spectrum of illnesses seen in modern CICU. With this dual expertise, the critical care cardiologist is uniquely positioned to coordinate multidisciplinary care for CS patients-integrating hemodynamic data, knowledge of multiorgan insult and failure driven by shock, procedural skill, and interpersonal influence to foster collaboration and timely decision-making within CS teams. This review aims to provide the history and development of CCC, discuss intensive care unit staffing models, and summarize the evidence supporting CS team utilization. Finally, we propose that continued investment in CCC training, research, and infrastructure is crucial to meet the demands of patients in the modern CICU.