Figure 3: A Selection of Recommendations of the German-Austrian S3 Guideline “Cardiogenic Shock Complicating Myocardial Infarction”.

Recommendation grades of the German-Austrian S3 guideline:[14,15] ↑↑: Strongly recommended (‘shall’). ↑: Recommended (‘should’). ↔: No recommendation (‘may’) (no confirmed study results exist that demonstrate either a beneficial or a harmful effect). ↓: Rejected (‘should not’) (negative recommendation). ↓↓: Strongly rejected (‘shall not’) (strong negative recommendation). Evidence levels of the German-Austrian S3 guideline:[14,15] Evidence levels in detail are described in Werdan et al.[14] and Werdan et al.[15] Level 1+ evidence (‘well performed systematic reviews of RCTs or RCTs with a low risk of bias’): E 13 (first half sentence), E 38 (‘with levosimendan being preferred [↑]’) and E 100. All other recommendation rely on evidence of the combined level 3/4 (‘non-analytical studies/consensus opinion of experts based on studies and clinical experience or in the interests of patients’ safety [e.g. monitoring]). Reproduced from Werdan, et al., 2012.[14]