Key result
Mixed shock ranks as the second leading cause of CICU shock, prompting a hemodynamic classification framework.
Why the study?
Mixed cardiogenic shock is the second leading cause of shock in contemporary coronary intensive care units, but standardized classification frameworks, well-established hemodynamic definitions, and high-quality evidence to guide routine care are lacking.
Proposes a standardized classification framework and hemodynamic definition for mixed cardiogenic shock to improve patient phenotyping in trials and guide clinical management.
Offers framework for phenotyping mixed cardiogenic shock; leaves open prospective validation before guiding trials or practice.
The classification of cardiogenic shock (CS) has evolved from a singular cold-and wet-hemodynamic profile. Data from registries and clinical trials have contributed to a broader recognition that although all patients with CS have insufficient cardiac output leading to end organ hypoperfusion, there is considerable variability in CS acuity, underlying etiologies, volume status, and systemic vascular resistance. Mixed CS can be broadly categorized as CS with at least 1 additional shock state. Mixed CS states are now the second leading cause of shock in contemporary coronary intensive care units, but there is little high-quality evidence to guide routine care, and there are no standardized classification frameworks or well-established hemodynamic definitions. This primer summarizes the current epidemiology and proposes a classification framework and invasive hemodynamic parameters to guide categorization that could be applied to help better phenotype patients captured in registries and trials, as well as guide management of mixed CS states.
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Diepen et al. (2024) conducted a review in Mixed cardiogenic shock. Standardized classification framework and invasive hemodynamic definition was evaluated. Mixed cardiogenic shock (cardiogenic shock with ≥1 additional shock state) is the 2nd leading cause of shock in coronary ICUs, prompting a proposed hemodynamic classification framework.
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