Definition, Classification, and Management of Primary Non-Cardiac Causes of Cardiogenic Shock.

Abstract

Cardiogenic shock is a complex syndrome presenting with a critical state of cardiac output insufficient to support end-organ perfusion requirements. Contemporary cardiogenic shock classification recognizes broad categories of primary cardiac etiologies of cardiogenic shock, such as acute myocardial infarction and heart failure. Primary non-cardiac etiologies of cardiogenic shock, however, are poorly described in literature and have not been captured by any contemporary classification, leading to challenges in diagnosing and managing these cases. In this review, we propose that primary non-cardiac causes of cardiogenic shock be recognized as its own category that builds on the original Shock Academic Research Consortium classification with its own additional modifiers. We present a detailed framework that groups each non-cardiac cause by its underlying disease mechanism (vascular, infectious, inflammatory, traumatic, toxic, cancer-related, endocrine, metabolic) and review available literature on their respective management strategies. We expect that the ability to classify primary non-cardiac causes of cardiogenic shock will help with early identification and targeted management of the primary non-cardiac insult, support patients through their shock state, and may lead to improvement of in-hospital cardiogenic shock mortality rates in clinical practice. Moreover, this new framework can further assist clinical trial classifications to properly phenotype cardiogenic shock for clinical research purposes.