SCAI Classification of Cardiogenic Shock

Physical Exam

Biochemical Markers

Hemodynamics

Stage

normal JVP; lung fields clear, warm and well-perfused

normal

normal

at risk (A)

elevated JVP, rales, warm and well-perfused

minimal renal impairment, elevated BNP, normal lactate

SBP < 90 or MAP < 60 or > 30 mm Hg drop from baseline; pulse >= 100

beginning (B)

looks unwell; ashen; mottled; extensive rales; cold and clammy; altered mental status; reduce urine output

lactate 2.0-4.9 mmol/L; elevated BNP; creatinine doubled or > 50% drop in GFR

drugs or devices required to maintain blood pressure; cardiac index < 2.2; PCWP > 15; cardiac power output <= 0.6

classic (C)

as for Stage C

deteriorating from Stage C

multiple pressors or mechanical circulatory support device

deteriorating (D)

ongoing CPR and/or ECMO

pH <= 7.2; lactate >= 5 mmol/L

cardiac collapse; mechanical ventilation; defibrillator used

in extremis (E)