Cardiogenic Shock: SCAI Stage Classification

With a close to 50% mortality rate for cardiogenic shock, we all need a do a better job of caring for these patients. A cardiogenic shock classification would help identify who needs the most help.
This is created for anyone caring for cardiogenic shock including physicians, APPs and nurses.
We are all in this together.
The earlier we intervene, the better patients do.
The SCAI shock stage classification is a tool to help us sort out the next step in management.
Stage A are patients At risk.
They are normotensive with a normal lactate but had a significant MI or decompensated heart failure.
Stage B are Beginning to go into cardiogenic shock.
They’re a little unstable with some hypotension or tachycardia but their perfusion is alright.
Their lactate is still normal.
Stage C are the Classic Cardiogenic Shock patients.
These patients need a bit more help with an elevated lactate and need pharmacologic or mechanical help.
The recommendation here is for invasive hemodynamic monitoring.
We’re talking about arterial lines and PA catheters.
Stage D are the Deteriorating patients.
What you’ve been doing just isn’t cutting it.
Vasopressors and inotrope doses are increasing to no avail.
If your patients doesn’t have mechanical circulatory support, they likely are not going to survive.
Stage E are those patients in Extremis.
Here is too late. There is actual or impending cardiac arrest.

Citation for the Cardiogenic Shock Classification

Naidu SS, Baran DA, Jentzer JC, Hollenberg SM, van Diepen S, Basir MB, Grines CL, Diercks DB, Hall S, Kapur NK, Kent W, Rao SV, Samsky MD, Thiele H, Truesdell AG, Henry TD. SCAI SHOCK Stage Classification Expert Consensus Update: A Review and Incorporation of Validation Studies: This statement was endorsed by the American College of Cardiology (ACC), American College of Emergency Physicians (ACEP), American Heart Association (AHA), European Society of Cardiology (ESC) Association for Acute Cardiovascular Care (ACVC), International Society for Heart and Lung Transplantation (ISHLT), Society of Critical Care Medicine (SCCM), and Society of Thoracic Surgeons (STS) in December 2021. J Am Coll Cardiol. 2022 Mar 8;79(9):933-946. doi: 10.1016/j.jacc.2022.01.018. Epub 2022 Jan 31. PMID: 35115207.
Link to Article

Added 10.02.22
Baran DA, Grines CL, Bailey S, Burkhoff D, Hall SA, Henry TD, Hollenberg SM, Kapur NK, O’Neill W, Ornato JP, Stelling K, Thiele H, van Diepen S, Naidu SS. SCAI clinical expert consensus statement on the classification of cardiogenic shock: This document was endorsed by the American College of Cardiology (ACC), the American Heart Association (AHA), the Society of Critical Care Medicine (SCCM), and the Society of Thoracic Surgeons (STS) in April 2019. Catheter Cardiovasc Interv. 2019 Jul 1;94(1):29-37. doi: 10.1002/ccd.28329. Epub 2019 May 19. PMID: 31104355.
Link to Article

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