From guideline to precision: echocardiography in the management of cardiogenic shock

Cardiogenic shock is a life-threatening condition characterized by critically reduced cardiac index in the absence of hypovolaemia, resulting in systemic hypoperfusion, systemic oxygen delivery-to-consumption mismatch, and high mortality. This review aims to outline the phenotypes of cardiogenic shock with the aid of echocardiography.

Despite recent advances in diagnosis and treatment, the mortality rate of cardiogenic shock still approaches 50%. Echocardiography can help with swift diagnosis and therapy targeted at ischaemic and nonischaemic causes of left ventricular systolic failure, diastolic failure with preserved left ventricular ejection fraction, predominant right ventricular failure, severe valvular heart disease, and left ventricular outflow tract obstruction. Echocardiography is indispensable for the decision-making process regarding extracorporeal life support in cardiogenic shock refractory to therapy.

In addition to complex echocardiographic data that allow for patient-tailored therapy, the echocardiographic assessment of cardiac index and stroke volume has recently become part of the basic echocardiography syllabus for intensivists. A low left ventricular outflow velocity-time integral implies severely reduced forward flow, providing clinicians with an objective parameter to determine the diagnosis of cardiogenic shock, therapeutic intervention, or the need for mechanical circulatory support.