Early Recognition and Risk Stratification in Cardiogenic Shock: Well Begun Is Half Done

Abstract

Cardiogenic shock is a complex syndrome manifesting with distinct phenotypes depending on the severity of the primary cardiac insult and the underlying status. As long as therapeutic interventions fail to divert its unopposed rapid evolution, poor outcomes will continue challenging health care systems. Thus, early recognition in the emergency setting is a priority, in order to avoid delays in appropriate management and to ensure immediate initial stabilization. Since advanced therapeutic strategies and specialized shock centers may provide beneficial support, it seems that directing patients towards the recently described shock network may improve survival rates. A multidisciplinary approach strategy commands the interconnections between the strategic role of the ED in affiliation with cardiac shock centers. This review outlines critical features of early recognition and initial therapeutic management, as well as the utility of diagnostic tools and risk stratification models regarding the facilitation of patient trajectories through the shock network. Further, it proposes the implementation of precise criteria for shock team activation and the establishment of definite exclusion criteria for streaming the right patient to the right place at the right time.

Echocardiography as a Vital Tool in Assessing Shock: A Comprehensive Review

“…Additionally, the differentiation between certain types of shock using echocardiography poses a challenge, particularly in scenarios where distributive shocks like hypovolemic shock and early septic shock may exhibit analogous findings in imaging studies [37]. This limitation underscores the complexity of precisely identifying the etiology of shock solely based on echocardiographic findings, necessitating a comprehensive approach incorporating other clinical parameters and diagnostic modalities [38]. While echocardiography is a valuable tool in assessing shock, addressing these technical challenges is pivotal to optimizing its diagnostic utility and ensuring timely and accurate management of patients in shock states.…”