Quick Chart
  • Cardiogenic shock is a haemodynamically complex syndrome characterised by low cardiac output that often culminates in multiorgan system failure and high rates of death.
  • Cardiogenic shock is manifest as persistent hypotension (> 30 mins) with systolic BP < 90mmHg or MAP 30mmHg below baseline

Read the complete article; Shock in the Medical Library >  Pathophysiology.

 Clinical Presentation
  • Patient history (see risk factors)
  • Tachypnoea and/or hypoxia
  • Chest pain / discomfort / ACS (not always present)
  • Pulmonary congestion (incl. wheeze and/or crackles)
  • Sustained hypotension
  • Jugular vein distension
  • Poor perfusion
  • Oliguria
  • Peripheral oedema
 Exclusion Criteria
Exclusion Criteria
 Risk Assessment

Risk factors for the ACS patient developing cardiogenic shock are:

  • Fainting and/or impaired LOC
  • Poor perfusion (pallor)
  • Cold, clammy skin
  • Dyspnoea
  • Pulmonary congestion
  • Peripheral cyanosis
  • Hyperglycaemia (BGL > 11.1 mmol/l)
Primary Care
Intermediate Care
  • Apply cardiac monitor if trained and authorised.
  • If IV in situ, maintenance fluid TKVO only.
  • Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
  • Transport Priority 1 if patient time critical, pre-notifying receiving facility
Advanced Care
  • Continuous cardiac monitoring
  • Perform 12-lead ECG
  • Manage Acute Coronary Syndrome if present per relevant CPG
  • Establish vascular access and collect prehospital bloods
  • Consider fluid therapy to maintain perfusion
  • Transport Priority 1 if patient time critical, pre-notifying receiving facility. Consider ECMO facility for peri-arrest patient.
Critical & Extended Care
  • As per Advanced Care guidelines
 Additional Information
  • Anticipate cardiac arrest – more than 50% of cardiogenic shock patients arrest
  • Titrate fluid to manage symptomatic hypotension and do not fluid overload
  • Do not try to suction any more than necessary to maintain clear airway as fluid will be continuously flowing
Key Terms & Links
Extended Care:
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