Expert Consensus Statement on the Evaluation, Treatment, and Transfer of Cardiogenic Shock Using a Delphi Method Approach　― A Report of the Japan Critical Care Cardiology Committee (J4CS) ―

Abstract

Recent advances in pharmacological agents and mechanical circulatory support (MCS) have led to significant progress in the treatment of patients with cardiogenic shock (CS); however, mortality remains high.According to reports analyzing nationwide clinical data, CS-related in-hospital or 30-day mortality due to acute myocardial infarction remains high, at approximately 33-42% in Japan and 27-51% in Europe and North America. 1-3Historically, CS treatment has largely depended on the individual experiences of facilities and clinicians.Recently, various countries have been making efforts to standardize CS treatment.A significant challenge in CS management in critical care cardiology practice is the rapid progression of the disease in a short period.We believe that a standardized approach in this area can improve survival rates through prompt decision-making and intervention.Therefore, this expert consensus aims to propose a management algorithm for CS focusing on the early phase.Given the limited evidence on CS and the small sample size of studies from Japan, this consensus refrains from addressing recommendation levels and presents the treatment algorithm as an expert consensus.This consensus is intended for use by various professionals engaged in critical cardiology care, encouraging dialog, continuous revisions, and standardization of CS treatment. MethodsThis study aimed to develop an algorithm for the evaluation, treatment, and transfer of patients suspected of or with CS along the timeline from the point of suspicion to care in a cardiac intensive care unit (CICU) or cardiovascular intensive care unit (CVICU).To develop this consensus, a group of 9 expert panelists (T.

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