2026 ESC Definition of Cardiogenic Shock Updates in Medicine

Updates in Medicine

The document defines cardiogenic shock by the presence of end‑organ hypoperfusion at rest, a hemodynamic abnormality, and cardiac dysfunction that matches the shock state. It details the clinical signs of hypoperfusion such as altered mental status, cold skin, prolonged capillary refill, and oliguria, as well as objective markers like lactate >2 mmol/L and low mixed venous oxygen saturation. Hemodynamic thresholds include systolic BP <90 mmHg or MAP <65 mmHg, elevated filling pressures, and a cardiac index <2.2 L/min/m². Cardiac dysfunction may involve severe left or right ventricular impairment, biventricular failure, or persistent ventricular arrhythmias, while emphasizing that reduced ejection fraction alone is insufficient for diagnosis. The guide also clarifies that normotensive or euvolemic presentations can still represent cardiogenic shock and that blood pressure must be interpreted alongside tissue perfusion and cardiac output.