This protocol addresses the high-mortality presentation of acute decompensated heart failure complicated by cardiogenic shock — specifically when systolic blood pressure falls below 90 mm Hg alongside evidence of end-organ hypoperfusion due to impaired cardiac output.
Cardiogenic shock is characterized by a critical reduction in cardiac output resulting in end-organ dysfunction. Hypotension — a systolic blood pressure below 90 mm Hg — is the primary clinical manifestation, but diagnosis also requires evidence of end-organ hypoperfusion as a direct consequence of cardiac dysfunction.
When pharmacologic management cannot maintain end-organ function, temporary mechanical circulatory support is a central component of the evidence-based approach in this setting.
The complete structured regimen — including device selection, decision criteria, and sequencing — is available in the full protocol below.
DOI: 10.1161/CIR.0000000000001063
Cardiogenic shock is a commonly encountered clinical challenge with a high mortality and is characterized by a critical reduction in cardiac output manifest by end-organ dysfunction.
Hypotension (eg, SBP <90 mm Hg) is the primary clinical manifestation of shock but is not sufficient for the diagnosis.
Additionally, end-organ hypoperfusion should be present as a consequence of cardiac dysfunction.
In patients with cardiogenic shock, temporary MCS is reasonable when end-organ function cannot be maintained by pharmacologic means to support cardiac function.
In patients with advanced HFrEF and hemodynamic compromise and shock, temporary MCS, including percutaneous and extracorporeal ventricular assist devices, are reasonable as a “bridge to recovery” or “bridge to decision.”
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