Therapeutic Phases in Cardiogenic Shock—Part 1 Recognize/Rescue and Optimization

The ‘therapeutic journey’ of cardiogenic shock can be divided into four phases—Recognize/Rescue, Optimization, Stabilization and Exit/de-Escalation (ROSE). Recognition of cardiogenic shock includes the diagnosis, staging and phenotyping of cardiogenic shock to guide the deployment of medical and mechanical circulatory support. Early recognition and institution of ‘rescue’ interventions are associated with better clinical outcomes in cardiogenic shock. Medical therapy should be optimized following initial ‘rescue’ with the aim of improving global oxygen delivery and perfusion pressure, while minimizing the risks associated with the therapy. Mechanical circulatory support is indicated in refractory cardiogenic shock.