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. 2019 May 8;6(1):e000960. doi: 10.1136/openhrt-2018-000960

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© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Conceptual algorithm for the management of cardiogenic shock (CS). The pathophysiology of CS is characterised by impaired cardiac output, SIRS, end-organ hypoperfusion and maladaptive compensatory mechanisms. Prevention of progressive cardiac and systemic compromise requires early recognition typically requiring right and left catheterisation and interruption of the vicious cycle by addressing underlying insults and initiation of mechanical circulatory support matched to the degree of clinical decompensation. Clinical indices such as CPI for LV function, PAPi for right ventricular function, and presence of malignant clinical features such as arrhythmia and hypoxaemia may help guide the decision for the most appropriate MSC modality. Bi-V, biventricular; CPI, Cardiac Power Index; LV, left ventricular; MCS, mechanical circulatory support; MI, myocardial infarction; PAPi, Pulmonary Artery Pulsatility Index; SIRS, systemic inflammatory response syndrome.