Table 6.5. Descriptors of shock stages: physical exam, biochemical markers, and hemodynamics.
| Stage of CS | Bedside findings | Biomarkers | Hemodynamics |
|---|---|---|---|
| A (at risk) | Normal JVP Lung sounds clear Dry-warm profile Strong distal pulses Normal mentation |
Normal labs Normal renal function Normal lactate |
SBP ≥ 100 mm Hg (or normal for patient) If PAC: • CI ≥ 2.5L/min/m2 • CVP < 10 mm Hg • SvO2 ≥ 65% |
| B (beginning) | High JVP Rales in lung fields Dry-warm profile Strong distal pulses Normal mentation |
Normal lactate Minimal renal dysfunction Elevated BNP |
SBP < 90 OR MAP < 60 OR > 30 mm Hg drop from baseline HR ≥ 100 bpm If PAC: CI ≥ 2.2 L/min/m2 SvO2 ≥ 65% |
| C (classic) |
May include any of: Looks unwell Panicked Ashen, mottled, dusky Volume overload Extensive rales Kilip class 3 or 4 BiPap or mechanical ventilation Cold, clammy Acute alteration in mental status Urine output < 30 mL/h |
May include any of: Lactate ≥ 2 mmol/L Creatinine doubling OR > 50% drop in GFR Altered liver enzymes Elevated BNP |
May include any of: SBP < 90 OR MAP < 60 OR >30 mm Hg drop from baseline. Pressor drugs and/or devices used to maintain BP PAC: • CI < 2.2L/min/m2 • PCWP > 15 mm Hg • CVP/PCWP ≥ 0.8 • PAPi < 1.85 • CPO ≤ 0.6W |
| D (deteriorating) | May include any of the findings from stage C | Any of stage C and deteriorating. |
Any of stage C and: Requiring multiple pressors and/or addition of mechanical circulatory support devices to maintain perfusion |
| E (extremis) | Near pulselessness Circulatory collapse Mechanical ventilation Defibrillator used |
CRA (A-modifier*) pH ≤ 7.2 Lactate ≥ 5 mmol/L |
Inaudible SBP / CRA VTWP or refractory VT/VF Hypotension despite maximal support |
The modifier (A) is used to describe patients who have gone into cardiac arrest, regardless of duration.
Adapted from Baran DA et al.58SCAI clinical expert consensus statement on the classification of cardiogenic shock. Catheter Cardiovasc Interv. 2019; 94(1):29-37.
AMI: acute myocardial infarction; BiPap: bi-level positive airway pressure; BNP: B-type natriuretic peptide; CI: cardiac index; CPO: cardiac power output; CS: cardiogenic shock; CVP: central venous pressure; GFR: glomerular filtration rate; HF: heart failure; HR: heart rate; JVP: jugular venous pressure; MAP: mean arterial pressure; PAC: pulmonary artery catheter; PAPi: pulmonary artery pulsatility index; PCWP: pulmonary capillary wedge pressure; SBP: systolic blood pressure; SvO2: mixed venous oxygen saturation; VF: ventricular fibrillation; VT: ventricular tachycardia; VTWP: ventricular tachycardia without a pulse.