Updated SCAI SHOCK Stages Classification
The SCAI SHOCK classification is intended to provide clinicians and researchers with a unified and standardized vocabulary that will translate across all settings. Additionally, the system aims to facilitate recognition of risk for adverse outcomes, potential for benefit from various interventions and prognosis, with the goal of reducing mortality on an individual as well as a national scale.
The latest update includes a 3-axis model that places the shock stage in context with other predictors of mortality, such as etiology, phenotype, and non-modifiable risk factors such as age and frailty. It also provides a more useful cardiac arrest modifier and clarifies the constituent domains of the classification, including physical examination, biochemical, and hemodynamic criteria.
Bedside Checklist
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Quality Improvement Tool
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This educational tool provides users with organized high-yield information to assist them with the following:
- Identifying and staging patients with cardiogenic shock before clinical deterioration occurs.
- Optimizing interdisciplinary communication between providers taking care of shock patients.
Suitable for use as a point-of-care reference in high-acuity patient settings, such as the cardiac cath lab, intensive care unit, emergency department, or any rapid-response area, this tool is also appropriate for use at the patient's bedside to provide an efficient yet thorough approach to identifying patients with cardiogenic shock. Once shock is identified, the tool guides team members through additional information gathering and interdisciplinary communication requirements.
Validation Studies
- “Influence of intra-aortic balloon pump on mortality as a function of cardiogenic shock severity” (Jentzer, et al)
- “Clinical Outcomes Associated with Acute Mechanical Circulatory Support Utilization in Heart Failure Related Cardiogenic Shock” (Hernandez-Montfort, et al)
- “Incidence and outcomes of acute kidney injury stratified by cardiogenic shock severity” (Padkins, et al)
- “The Range of Cardiogenic Shock Survival by Clinical Stage: Data From the Critical Care Cardiology Trials Network Registry” (Lawler, et al)
- “Systemic Inflammatory Response Syndrome Is Associated With Increased Mortality Across the Spectrum of Shock Severity in Cardiac Intensive Care Patients” (Jentzer, et al)
- “Defining Shock and Preshock for Mortality Risk Stratification in Cardiac Intensive Care Unit Patients” (Jentzer, et al)
- “The Stages of CS: Clinical and Translational Update” (Baran, et al)
- “Complete Hemodynamic Profiling With Pulmonary Artery Catheters in Cardiogenic Shock Is Associated With Lower In-Hospital Mortality” (Kapur, et al)
- “Prospective validation of the SCAI shock classification: Single center analysis” (Baran, et al)
- “Invasive Hemodynamic Assessment and Classification of In-Hospital Mortality Risk Among Patients With Cardiogenic Shock” (Thayer, et al)
- “Understanding Cardiogenic Shock Severity and Mortality Risk Assessment” (Jentzer, et al)
- “SCAI shock classification in acute myocardial infarction: Insights from the National Cardiogenic Shock Initiative” (Hanson, et al)
- “Cardiogenic Shock Classification to Predict Mortality in the Cardiac Intensive Care Unit” (Jentzer, et al)
- “Admission SCAI shock stage stratifies post-discharge mortality risk in cardiac intensive care unit patients” (Jentzer, et al)
- “Application of the SCAI classification in a cohort of patients with cardiogenic shock” (Westermann, et al)
- “SCAI cardiogenic shock classification after out of hospital cardiac arrest and association with outcome?”
- SCAI Cardiogenic Shock Classification After Out of Hospital Cardiac Arrest (Pareek, et al)
- SCAI Cardiogenic Shock Classification for Predicting In-Hospital and Long-Term Mortality in Acute Heart Failure (Burgos, et al)
- Society for Cardiovascular Angiography and Intervention Shock Classification Predicts Mortality After Out-of-Hospital Cardiac Arrest (Sarma, et al)
- Cardiogenic Shock Severity and Mortality In Patients Receiving Venoarterial Extracorporeal Membrane Oxygenator Support (Jentzer, et al)
- Shock Severity Assessment in Cardiac Intensive Care Unit Patients With Sepsis and Mixed Septic-Cardiogenic Shock (Jentzer, et al)
- Association Between the Acidemia, Lactic Acidosis, and Shock Severity with Outcomes in Patients with Cardiogenic Shock (Jentzer, et al)
- Intra-Aortic Balloon Pump Reduces 30-Day Mortality in Early-Stage Cardiogenic Shock Complicating Acute Myocardial Infarction According to SCAI Classification (Luo, et al)
- SCAI Stage Reclassification at 24 H Predicts Outcome of Cardiogenic Shock: Insights From the Altshock‐2 Registry (Morici, et al)
- Serial Assessment of Shock Severity in Cardiac Intensive Care Unit Patients (Jentzer, et al)
- Systematic Assessment of Shock Severity in Postoperative Cardiac Surgery Patients (Roeschl, et al)
- Society for Cardiovascular Angiography and Interventions Shock Classification to Stratify Outcomes of Extracorporeal Membrane Oxygenation (Mehta, et al)
- Prognostic performance of the SCAI shock classification at admission and during ICU treatment: A retrospective, observational cohort study (Britsch, et al)
- Validation of the CREST Model and Comparison with SCAI Shock Classification for the Prediction of Circulatory Death in Resuscitated Out-of-Hospital Cardiac Arrest (Watson, et al)
- Shock Severity Classification and Mortality in Adults With Cardiac, Medical, Surgical, and Neurological Critical Illness (Jentzer, et al)
- Implementation of Society for Cardiovascular Angiography and Interventions Classification in Patients with Cardiogenic Shock Secondary to Acute Myocardial Infarction in a Spanish University Hospital (Cervera, et al)
- Prognostic Performance of Serial Determination of the Society For Cardiovascular Angiography and Interventions Shock Classification in Adults with Critical Illness (Jentzer, et al)
- Prognostic Utility of Society for Cardiovascular Angiography and Interventions Shock Stage Approach for Classifying Cardiogenic Shock Severity in Takotsubo Syndrome (Cambor-Blasco, et al)
- Distribution and 24-Hour Transition of SCAI Shock Stages and Their Association with 30-Day Mortality in Acute Myocardial Infarction (Pham, et al)
SCAI Classification Ancillary Studies
- Application of the SCAI Classification to Admission of Patients with Cardiogenic Shock: Analysis of a Tertiary Care Center in a Middle-Income Country (Gonzalez-Pacheco, et al)
- Noninvasive Hemodynamic Assessment of Shock Severity and Mortality Risk Prediction in the Cardiac Intensive Care Unit (Jentzer, et al)
- Gender Differences in Cardiogenic Shock Patients: Clinical Features, Risk Prediction, and Outcomes in a Hub Center (Lozano-Jimenez, et al)
SCAI/EAPCI/ACVC Expert Consensus Statement on Cardiogenic Shock in Women
Cardiovascular disease is the leading cause of death for women worldwide, with mortality rates due to cardiogenic shock (CS) remaining exceedingly high. Sex-based disparities in the timely delivery of optimal CS treatment contribute to poor outcomes; addressing these disparities is a major priority to improve women’s cardiovascular health.
This consensus statement provides a comprehensive summary of the current state of treatment of CS in women across the spectrum of cardiovascular disease states and identifies important gaps in evidence. As sex-based data are limited in contemporary literature, clinicians may use this document as a resource to guide practice.
Further investigations are necessary to inform best practices for the diagnosis and treatment of women with CS.
Online Learning
Complete these online educational activities to learn more about advances in cardiogenic shock treatment in the cath lab and access a wealth of trusted, quality online resources from past SCAI SHOCK meetings, including recorded presentations and downloadable PowerPoints in the SCAI conference library.
Quality Improvement Tips
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