Guidelines – Experts’ recommendations for the management of adult patients with cardiogenic shock

Nadia Aissaouia, Clément Delmas, Hamid Merdji, Guillaume Schurtz, Guillaume Baudry, Antoine Beurton, Florence Boissier, Laurent Bonello, Bernard Cholley, Nicolas Combaret, Alain Combes, Charles-Henri David, Daniel De Backer, Pierre Grégoire Guinot, Olfa Hamzaoui, Brahim Harbaoui, Julien Imbault, Nicolas Nesseler, Antoine Kimmoun, Michel Kindo, Guillaume Lebreton, Guillaume Leurent, Bruno Levy, Stéphane Manzo-Silberman, Anne-Céline Martin, Armand Mekontso-Dessap, Imane Adda, Joy Mootien, Alexandre Ouattara, Matteo Pozzi, Etienne Puymirat, Francois Roubille, Antonin Trimaille, Aurore Ughetto, Eric Van Belle, Eric Bonnefoy, Khaldoun Kuteifan

The last specific international European recommendations regarding the management of cardiogenic shock (CS) regardless of the etiology were issued over 10 years ago. We present herein recommendations for the management of CS in adults, developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system by an expert group of from the French Intensive Care Society [Société de Réanimation de Langue Française (SRLF)] and the French Society of Cardiology [Société Française de Cardiologie (SFC)], with the participation of the French Society of Anesthesia and Intensive Care [Société Française d’Anesthésie et de Réanimation (SFAR)], and the French Society of Thoracic and Cardiovascular Surgery [Société Française de Chirurgie Thoracique et Cardio-Vasculaire (SFCTCV)].

The recommendations covered six fields of application: CS teams and expert centers, symptomatic medical management, etiological management, organ support, temporary circulatory support and de-escalation and early post-CS management. Twenty-three “Patient Intervention Comparator Outcome” (PICO) questions were identified, leading to 41 recommendations regarding management of CS in adult patients. Seven recommendations were scored with high level of evidence (Grade 1), 11 with moderate level of evidence (Grade 2) and 17 with low level of evidence (Expert opinion). In 6 cases, the experts were not able to give an answer. All of the recommendations obtained strong agreement from the expert committee.

The experts highlight the fact that optimal management ofCSrequires organization including a structured, multidisciplinary shock teamandregionalreferralnetwork,applying standardizedprotocols fordiagnosis and staging. Early etiological treatment—such as culprit-lesion revascularization or urgent valve intervention—is central to improveoutcomes.Hemodynamic support should prioritize norepinephrine as first-line vasopressor and privilege selective inotrope use. Temporary mechanical circulatory support (Impella, VA-ECMO) should be reserved for carefully selected patients following discussion by the expert team.

• Cardiogenic shock

• Guidelines
• Temporary circulatory support
• Heart team

• Introduction
• Methodology
• Sustainability considerations in the management of patients with cardiogenic shock
• Conclusions and perspectives

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