Clinical Resources
SCAI Shock Classification
Cardiogenic Shock Staging (A–E)
Select the stage that best matches the patient's current clinical presentation. Classification guides escalation, mechanical circulatory support selection, and prognostication.
A
At Risk
Patient is not currently experiencing signs or symptoms of CS but is at risk (e.g., large acute MI, prior MI with HF).
Hemodynamics: Normal BP, HR normal. Lactate: Normal. Perfusion: Warm, well-perfused.
B
Beginning CS
Relative hypotension or tachycardia without hypoperfusion. May respond to low-dose vasopressors or inotropes.
Hemodynamics: SBP <90 or MAP <60, or >30 mmHg drop from baseline. Lactate: Normal. Perfusion: Warm, adequate urine output.
C
Classic CS
Hypoperfusion requiring intervention beyond volume resuscitation — inotropes, vasopressors, or mechanical circulatory support.
Hemodynamics: CI <2.2 L/min/m², PCWP >15 mmHg, CPO <0.6 W. Lactate: Elevated (≥2.0). Perfusion: Cool extremities, altered mental status, oliguria, elevated creatinine.
D
Deteriorating
Failure to stabilize despite initial interventions. Escalation of support is required.
Hemodynamics: Worsening despite ≥1 intervention. Lactate: Rising. Perfusion: Worsening end-organ function, requiring multiple pressors or MCS escalation.
E
Extremis
Cardiac arrest with ongoing CPR and/or ECMO, or refractory hemodynamic instability often supported by multiple MCS devices.
Hemodynamics: Near-pulselessness, cardiac arrest, PEA, refractory VT/VF. Lactate: Markedly elevated. Perfusion: Multi-organ failure, pH <7.2.
Clinical Notes
- Modifiers: Add "A" (for cardiac arrest) or "H" (for hypoxia) as a suffix when applicable (e.g., Stage C-A).
- CPO: Cardiac power output <0.6 W is a key hemodynamic marker distinguishing Stage C from B.
- Trajectory matters: A patient declining from B to C carries different urgency than a stable C.