Consensus Statements from the ISHLT Consensus Conference: Heart Failure Related Cardiogenic Shock

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Published 8 December 2023

David A. Baran, MD; Filio Billia, MD, PhD; Varinder Randhawa, MD, PhD; Jennifer A. Cowger, MD, MS; Christopher M. Barnett, MD, MPH; Sharon Chih, MBBS, PhD; Stephan Ensminger, MD, DPhil; Jaime Hernandez-Montfort, MD, MSc; Shashank S. Sinha, MD, MSc; Esther Vorovich, MD, MSCE; Alastair Proudfoot, MD, PhD; Hoong Sern Lim, MD; Vanessa Blumer, MD; Douglas L. Jennings, PharmD; A. Reshad Garan, MD; Maria Florencia Renedo, MD; Thomas C. Hanff, MD MSCE; Manreet K. Kanwar, MD

J Heart Lung Transplant. Dec 2023

  • Advanced Heart Failure & Transplantation
  • Cardiology
  • Cardiothoracic Surgery
  • Consensus Document
  • Mechanical Circulatory Support
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  • Standards & Guidelines

The last decade has brought tremendous interest in the problem of cardiogenic shock. The bulk of studies have been in patients with acute myocardial infarction, and there is little evidence to guide the clinician in those patients with heart failure cardiogenic shock (HF-CS).

An International Society for Heart and Lung Transplant consensus conference was organized to better define, diagnose, and manage HF-CS. There were 54 participants (advanced heart failure and interventional cardiologists, cardiothoracic surgeons, critical care cardiologists, intensivists, pharmacists, and allied health professionals) with vast clinical and published experience in CS, representing 42 centers worldwide. This consensus report summarizes the results of a premeeting survey answered by participants and the breakout sessions where predefined clinical issues were discussed to achieve consensus in the absence of robust data.

Key issues discussed include systems for CS management, including the “hub-and-spoke” model vs a tier-based network, minimum levels of data to communicate when considering transfer, disciplines that should be involved in a “shock team,” goals for mechanical circulatory support device selection, and optimal flow on such devices.
Overall, the document provides expert consensus on some important issues facing practitioners managing HF-CS. It is hoped that this will clarify areas where consensus has been reached and stimulate future research and registries to provide insight regarding other crucial knowledge gaps.

Read at JHLT

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