Cardiology Letters 2026, 35(2):99-112

Current approach to cardiogenic shock management

Elena Teringová

Oddelenie akútnej kardiológie, Kardiologická klinika LF UK a NÚSCH, a. s., Bratislava, Slovenská republika

Cardiogenic shock is a severe syndrome that continues to be associated with high mortality despite advances in diagnostics and treatment. In recent years, significant progress has been made in establishing relevant definitions, classifications, and refining therapeutic approaches. The introduction of the SCAI staging systwem, the SHARC etiological classification, and hemodynamic phenotyping has enabled more accurate risk stratification and more effective therapeutic decision-making. Early diagnosis based on clinical, laboratory, and imaging parameters is essential for the prompt initiation of treatment. Management consists of a combination of initial hemodynamic stabilization and causal therapy, with the use of temporary mechanical circulatory support in selected cases. The role of temporary mechanical circulatory support is evolving dynamically as new evidence emerges. While routine use is not recommended, its application in a selected group of patients has been associated with improved clinical outcomes. Careful patient selection, appropriate timing, and adequate choice of support modality are essential. The results from recent observational studies also support the use of advanced invasive monitoring with a pulmonary artery catheter. A multidisciplinary approach through dedicated shock teams has shown benefit in improving the organization of care, increasing the use of advanced diagnostic and therapeutic strategies, and improving clinical outcomes. This review summarizes the current recommendations of professional societies for the diagnosis and management of cardiogenic shock, emphasizing the need for individualized approach. At the same time, it highlights the need for further high-quality randomized studies to optimize the treatment of this heterogenous condition.

Keywords: cardiogenic shock; shock team; pulmonary artery catheter; vasoactive drugs temporary mechanical circulatory support

Published: February 1, 2026  Show citation