Choc Cardiogénique

Cardiogenic shock (CS) is a life-threatening acute cardiac failure syndrome leading to persistent hypoperfusion, entailing short-term mortality of 30–40% and exceeding 50% at one year. While acute myocardial infarction remains a major cause, cases related to acute or acute-on-chronic heart failure (HF) have been on the rise, underscoring the heterogeneity of CS.

Recent advances include refined classifications such as the Society for Cardiovascular Angiography and Interventions (SCAI) staging system, which effectively stratifies prognosis and guides management, and the growing adoption of multidisciplinary “shock teams” and regional networks. Though numerous position papers and reviews are published every year, the most recent specific international guidelines on management of CS regardless of the etiology were issued over 10 years ago.

Over the past decade, multiple studies have investigated CS and its symptomatic treatments, including inotropes and mechanical circulatory support, but most have yielded negative results. In contrast, and despite the increasing performance of percutaneous interventions for severe valvular disease, randomized trials specifically addressing etiological management remain scarce.

To address this gap, the French-Language Society of Intensive Care(Société de Réanimation de Langue Française (SRLF)) and the French Cardiology Society (SFC) convened a multidisciplinary task force to develop evidence-based recommendations using the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. Twenty-three “Patient Intervention Comparator Outcome” (PICO) questions were identified across six domains of CS care, leading to 41 recommendations regarding management of CS in adult patients. These guidelines aim to provide an updated, pragmatic framework for clinicians managing this complex syndrome.