58
Treatment
Table 24. Society for Cardiovascular Angiography and
Interventions (SCAI) Cardiogenic Shock Criteria
Stage Bedside Findings
Selected
Laboratory
Markers Hemodynamics
A: At risk
• Normotensive
• Normal perfusion
• Cause for risk
for shock such as
large myocardial
infarction or HF
• Normal venous
pressure
• Clear lungs
• Warm extremities
• Strong palpable
pulses
• Normal mentation
• Normal renal
function
• Normal lactate
• SBP >100 mm Hg
• Hemodynamics:
Normal
B: Beginning shock
("pre-shock")
• Hypotension
• Normal perfusion
• Elevated venous
pressure
• Rales present
• Warm extremities
• Strong pulses
• Normal mentation
• Preserved renal
function
• Normal lactate
• Elevated BNP
a. SBP <90 mm Hg
b. MAP <60 mm Hg
or
c. >30 mm Hg
decrease from
baseline SBP
• HR >100 bpm
• Hemodynamics:
CI ≥2.2 L/min/m
2
C: Classic
cardiogenic shock
• Hypotension
• Hypoperfusion
• Elevated venous
pressure
• Rales present
• Cold, ashen, livedo
• Weak or
nonpalpable pulses
• Altered mentation
• Decreased urine
output
• Respiratory
distress
• Impaired renal
function
• Increased lactate
• Elevated BNP
• Increased LFTs
• Acidosis
• SBP <90 mm Hg ;
MAP <60 mm Hg ;
>30 mm Hg from
baseline SBP
despite drugs and
temporary MCS
• HR >100 bpm
• Hemodynamics:
CI ≤2.2 L/min/m
2
;
PCW >15 mm Hg;
CPO <0.6 W;
PAPi <2.0;
CVP-PCW >1.0
D: Deteriorating
• Worsening
hypotension
• Worsening
hypoperfusion
• Same as stage C • Persistent or
worsening values
of stage C
• Escalating use of
pressors or MCS
to maintain SBP
and end-organ
perfusion in
setting of stage C
hemodynamics
E: Extremis
• Refractory
hypotension
• Refractory
hypoperfusion
• Cardiac arrest
• CPR
• Worsening
values of stage C
laboratories
• SBP only with
resuscitation
• PEA
• Recurrent VT/VF
Adapted from Baran D, CCI 2019.
