Table 3.

SCAI Shock Stage Classification.

Adapted from SCAI Clinical Expert Consensus Statement on the Classification of Cardiogenic Shock

Stage	Description	Physical examination	Biomarkers	Hemodynamics
A	“At risk” for CS without signs and symptoms  Large AMI  Prior MI  Acute HF	Normal JVP Clear lungs Warm and well perfused  Strong distal pulses  Normal mentation	Normal labs Normal renal function Normal lactate	Normotensive  SBP ≥ 100 or normal for patient Hemodynamics  CI ≥ 2.5  CVP < 10  PA sat ≥ 65%
B	Relative hypotension or tachycardia without hypoperfusion	Elevated JVP Rales in lungs Warm and well perfused  Strong distal pulses  Normal mentation	Normal lactate Mildly impaired renal function Elevated BNP	Hypotensive  SBP < 90 OR MAP < 60 OR > ↓ 30 from baseline  Pulse ≥ 100 Hemodynamics  CI ≥ 2.2  PA sat ≥ 65%
C	Relative hypotension Hypoperfusion requiring intervention beyond volume resuscitation  Inotropes  MCS	Any of the following: Unwell appearing Volume overload Extensive rales Killip class 3 or 4 Mechanical ventilation Cold, clammy Acute AMS Urine output < 30-ml/h	Any of the following: Lactate ≥ 2  May be normal in chronic HF Creatinine ↑ × 2 OR > 50% ↓ GFR Increased LFTs Elevated BNP	Any of below: Hypotensive  SBP < 90 OR MAP < 60 OR > ↓ 30 from baseline  AND requires drugs/device to maintain BP Hemodynamics  CI < 2.2  PCWP > 15  RAP/PCWP ≥ 0.8  PAPI < 1.85  CPO ≤ 0.6
D	Worsening Stage C and failure to respond to initial interventions	Any of Stage C AND worsening signs and symptoms of hypoperfusion	Any of Stage C AND deteriorating Lactate rising	Any of Stage C AND requiring multiple pressors, escalating pressor doses, OR MCS to maintain perfusion
E	Ongoing cardiac arrest Requires support by multiple interventions or ECMO	Near pulselessness Cardiac collapse Mechanical ventilation Defibrillator used	CPR pH ≤ 7.2 Lactate ≥ 8	NO SBP without resuscitation PEA or refractory VT/VF Hypotension despite maximal support