Hemodynamic disorders must meet at least two of the three criteria. These include systolic blood pressure below 90 mmHg or mean blood pressure below 65 mmHg for more than 30 minutes, or the need for vasoactive drugs, increased heart filling pressure and a cardiac index below 2.2 l/min/m2 without the use of vasoactive drugs.
Hypoperfusion of organs must be confirmed by at least one clinical and one metabolic sign. Clinical signs include cold and wet skin, marbling of the skin, delayed capillary filling, a first-time disturbance of consciousness or arousal, as well as a decrease in diuresis of less than 0.5 ml/kg/h. Metabolic criteria include lactate levels above 2 mmol/L, a decrease in central or mixed venous oxygen saturation, usually below 55%, an increase in creatinine, transaminases, or other signs of organ dysfunction.
Cardiac dysfunction should be confirmed by signs of severe dysfunction of the left, right or both ventricles, severe valvular disease or mechanical complication. It is also necessary to take into account recurrent or persistent ventricular arrhythmias and exclude obstructive shock, for example, during cardiac tamponade.
To diagnose cardiogenic shock, three components must be present simultaneously: signs of hypoperfusion of organs at rest, hemodynamic disorders, and cardiac dysfunction corresponding to the severity of the condition. However, the presence of arterial hypotension is not a prerequisite for diagnosis. This approach makes it possible to detect, among other things, normotensive and euvolemic cardiogenic shock.
A standardized approach to the diagnosis of cardiogenic shock should be based on simultaneous assessment of hypoperfusion, hemodynamic disorders, and cardiac dysfunction. The proposed criteria can help to detect cardiogenic shock earlier and increase the uniformity of diagnosis in clinical practice and research.
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