Skip to main content
. Author manuscript; available in PMC: 2024 Jan 1.
Published in final edited form as: Circ Heart Fail. 2022 Dec 2;16(1):e009714. doi: 10.1161/CIRCHEARTFAILURE.122.009714

Table 2:

Revised CCCTN Adaptation Using the 2022 SCAI Staging Criteria

SCAI Stage SCAI Consensus Update (2022) 14 Revised CCCTN Algorithm (2022 SCAI Adaptation)
C
(“classic”)

  • Hypoperfusion requiring intervention beyond volume resuscitation

  • Typically have relative hypotension

  • Site-reported CS AND

  • Baseline eGFR <45 or worst ALT > 200 or worst lactate ≥2 AND

  • Use of MCS OR use of vasoactive agents as follows:
    • Low starting dose without escalation
    • Intermediate starting dose with de-escalation
D
(“deteriorating”)

  • Similar to stage C but getting worse

  • Failure to respond to initial interventions – requiring escalating doses or increasing numbers of pressors or addition of MCS

  • Lactate rising and persistently ≥ 2

  • Site-reported CS meeting at least stage C criteria AND

  • Worst lactate ↑ ≥ 50% if baseline lactate ≥ 2 OR

  • Use of MCS (new or > 1 device) initiated >24 h OR use of vasoactive agents as follows:
    • Low starting dose with escalation
    • Intermediate starting dose without escalation or de-escalation
    • High starting dose with de-escalation
E
(“extremis”)

  • Profound hypotension despite maximal hemodynamic support

  • May include cardiac arrest with coma or acute catastrophic event or failed interventions in stage D

  • Typically includes lactate ≥ 8, may include pH ≤ 7.2

  • Site-reported CS AND

  • Preceding CA with coma OR

  • Use of MCS (new or > 1 device) initiated >24h OR vasoactive agents as follows:
    • Intermediate starting dose with escalation
    • High starting dose without de-escalation

  • AND worst lactate ≥ 8 or worst pH ≤ 7.2*

Low, intermediate, and high starting doses of vasoactive agents correspond to a vasoactive-inotropic score at 4 hours of <20, 20-<40 and ≥40, respectively. Escalation and de-escalation correspond to an increase or decrease in vasoactive-inotropic score ≥10 points from 4 hours to 24 hours, respectively. If vasoactive dose information is missing, a single vasoactive agent meets the vasoactive agent criterion for stage C and ≥2 vasoactive agents meet the vasoactive agent criterion for stage D and E.

*

Stage E lab criteria were not required if meeting vasoactive agent dosing requirements based on the vasoactive-inotropic score.

Abbreviations: CA = cardiac arrest; CCCTN = Critical Care Cardiology Trials Network; CS = cardiogenic shock; eGFR = estimated glomerular filtration rate; MCS = mechanical circulatory support; SCAI = Society of Cardiovascular Angiography and Interventions.