This scientific statement provides a diagnostic framework, proposes a pediatric cardiogenic shock definition and severity staging, and outlines approaches to diagnosis and stabilization.
This AHA scientific statement provides a diagnostic framework, severity staging, and management guidance for pediatric cardiogenic shock to improve clinical outcomes.
Pediatric heart failure-related cardiogenic shock carries high morbidity and mortality but is understudied. Improving outcomes in pediatric cardiogenic shock hinges on timely diagnosis and appropriate triage, medical management tailored to the cause and phenotype of cardiogenic shock, and optimal timing of escalation to appropriate mechanical circulatory support. This scientific statement provides a diagnostic framework for the bedside clinician, in addition to proposing a pediatric cardiogenic shock definition and severity staging aligned with systems previously validated in other studies. It outlines the initial approach to diagnosis and stabilization of a child with suspected cardiogenic shock and offers guidance on optimal noninvasive and invasive monitoring strategies to determine clinical trajectory because a significant proportion of children with cardiogenic shock will continue to deteriorate in the first 24 hours. Last, it identifies future directions for the field, including educational interventions for the frontline clinicians seeing these patients, studying the role of a multidisciplinary shock team, evaluating the prognostic and clinical relevance of known and novel biomarkers, and leveraging all these to develop clinical decision tools or algorithms to guide nuanced management of these patients.
“Cardiogenic shock is a common presentation for children in acute decompensated HF, carries high morbidity, and has an extremely high mortality rate of 28%. To place in perspective, this is five times as high as pediatric septic shock and three times as high as the mortality of a STAT 5 congenital heart surgery at our center. Further, mortality is higher if the shock is more severe.”
This is the first comprehensive AHA scientific statement on pediatric cardiogenic shock, providing a much-needed standardized definition and severity staging system.
Puri et al. (Thu,) conducted a review in Pediatric cardiogenic shock. Diagnostic framework and severity staging was evaluated. This scientific statement provides a diagnostic framework, proposes a pediatric cardiogenic shock definition and severity staging, and outlines approaches to diagnosis and stabilization.
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