The Society of Cardiovascular Angiography and Interventions (SCAI) reported a classification for cardiogenic shock. The authors are from multiple institutions in the United States, Canada and Germany.
Patient selection: cardiogenic shock
(1) physical exam
(2) biochemical markers
normal JVP; lung fields clear, warm and well-perfused
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
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
as for Stage C
deteriorating from Stage C
multiple pressors or mechanical circulatory support device
ongoing CPR and/or ECMO
pH <= 7.2; lactate >= 5 mmol/L
cardiac collapse; mechanical ventilation; defibrillator used
in extremis (E)
In addition, the modifier subscript A is used if the patient has had a cardiac arrest.
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Specialty: Critical Care, Cardiology