Cardiogenic shock: a review of contemporary approaches and ongoing challenges

Cardiogenic shock (CS) is a complex condition characterized by insufficient cardiac output, tissue hypoperfusion, and life-threatening organ failure. In this review, we describe the definition, pathophysiology, classification, and approach to management in CS. We highlight recent advances in understanding the phenotypic heterogeneity and classification of CS. Then, we describe the limited, evidence-based, therapeutic approaches demonstrating survival benefit, including emergent revascularization of the culprit vessel in acute myocardial infarction related CS, and the use of a microaxial flow pumps in those with ST-segment elevation myocardial infarctions and CS. We also detail the limited evidence for other interventions, including medical therapies and other mechanical circulatory support (MCS) devices. Importantly, we highlight the current gaps in evidence and key ongoing trials that might inform the management of clinicians caring for patients with CS.