DIET & NUTRITION 
PATIENT EDUCATION 
OBESITY/WEIGHT MANAGEMENT 
EXERCISE/TRAINING 
LEGAL MATTERS 
GUIDELINES/RECOMMENDATIONS 
This article introduces the ACC’s first Concise Clinical Guidance (CCG) document on cardiogenic shock management, representing a new format designed to complement traditional guidelines. The CCG provides focused, actionable guidance with visual decision-making tools for a condition with rapidly evolving evidence base, emphasizing structured approaches to early recognition and interdisciplinary management.
Key Clinical Considerations
- The guidance presents both one-hour and 24-hour roadmaps for CS management, covering initial evaluation, team activation, stabilization with serial assessment, and appropriate escalation of temporary mechanical circulatory support (tMCS).
- Early recognition using the “SUSPECT CS” mnemonic is emphasized, incorporating laboratory markers and clinical assessment for congestion and hypoperfusion signs.
- A standardized, interdisciplinary team-based approach is recommended, with smaller centers advised to identify a “shock champion” and partner with advanced heart failure centers.
- The guidance highlights the importance of invasive hemodynamics in determining CS phenotype, assessing severity, and guiding tMCS device selection.
- The document compares commonly used tMCS devices and covers pharmacological management alongside critical care considerations.
Clinical Practice Impact
- Patient Communication: Structured approach facilitates clearer communication about CS severity, treatment options, and prognosis when discussing with patients and families.
- Practice Integration: Centers can use this guidance to develop standardized CS protocols and establish formal relationships with advanced heart failure centers.
- Resource Management: The partnership model between community centers and specialized facilities helps optimize resource utilization while improving patient outcomes.
- Action Items: Clinicians should identify local “shock champions,” implement the “SUSPECT CS” screening protocol, and establish clear criteria for tMCS consideration based on this guidance.
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