Evolving Evidence-Driven Strategies in Cardiogenic Shock Management

Although existing guidelines and expert consensus documents provide a general framework for management of cardiogenic shock (CS), a substantial body of evidence has yet emerged which has not been fully incorporated into current recommendations. This State-of-the Art review synthesizes both established and recent literature to provide an updated perspective on contemporary CS management. We review randomized controlled trials and key observational studies evaluating invasive hemodynamic monitoring, pharmacologic therapies, temporary mechanical circulatory support, and structural and valvular interventions. We critically appraise trial design, patient heterogeneity, and methodological limitations that influence interpretation and clinical applicability. Finally, we highlight persistent gaps and ongoing trials that aim to refine risk stratification and treatment strategies. This review provides a comprehensive, up-to-date synthesis of the CS literature and outlines key directions for future research and clinical practice.