As cardiogenic shock (CS) care becomes increasingly complex—with various support devices, biomarkers, hemodynamic profiles, etiologies, and patient characteristics influencing outcomes—tissue perfusion has emerged as the most reliable early and ongoing indicator of survival. 

The SCAI SHOCK classification is designed for repeated use to monitor CS progression, with worsening stages clearly linked to poorer outcomes. Among potential markers, serum lactate stands out as a practical and responsive bedside test that reflects changes in perfusion and management. This document highlights lactate as a promising marker for tracking CS trajectory and calls for further research to validate its use.

All authors: Srihari S. Naidu, MD, MSCAI; Sandeep Nathan, MD, MSc, FSCAI; Mir B. Basir, DO; FSCAI; David A. Baran, MD, FSCAI; Jeffrey Marbach, MBBS, FSCAI; and Cindy L. Grines, MD, MSCAI.