| Abstract [eng] |
Background: Cardiogenic shock (CS) remains one of the most severe conditions in cardiovascular med- icine and is still linked to a high short-term mortality rate of approximately 40-50%, despite significant advances in acute care. A major challenge in current research is the discrepancy between the increasing availability of mechanical circulatory support systems and the lack of corresponding improvements in clinical outcomes. Objective: This thesis aims to evaluate whether a stage and phenotype-guided management strategy, integrating hemodynamic profiling and structured systems of care, provides a more rational framework for therapeutic decision-making and helps to explain the persistent gap between technological progress and patient outcomes. Methods: This work is based on a structured narrative literature review conducted between August 2025 and April 2026, incorporating both traditional databases such as PubMed, National Library of Medicine, Google Scholar and AI-assisted academic platforms. Results: The analysis demonstrated that uniform treatment approaches are inadequate due to the marked heterogeneity of cardiogenic shock. A key advancement is the application of a three-axis model, which integrates shock severity (SCAI-stages A-E), underlying etiology (e.g. acute myocardial infarction vs heart failure) and clinical phenotype (e.g. left ventricular-dominant, right ventricular-dominant or mixed shock). Landmark clinical trials such as IABP-SHOCK II and ECLS-SHOCK were not able to show a survival benefit for the routine use of IABP or VA-ECMO in unselected patient populations. In contrast, the Dan- Ger Shock trial presented initialt evidence of a mortality benefit associated with mechanical circulatory support (MCS) (Impella CP), although this effect was confined to a carefully selected cohort of patients with STEMI-related left ventricular shock and no evidence of hypoxic brain injury. These findings un- derscore the importance of pathophysiology-guided device selection. In addition, the importance of organizational structures has become increasingly evident. The implemen- tations of multidisciplinary shock teams and regionalized hub-and-spoke networks is essential for early diagnosis, standardized triage and improvement of survival rates. Conclusion: A rational approach to the management of cardiogenic shock requires the integration of precise hemodynamic profiling and specialized systems of care. The persistent gap in clinical outcomes can largely be attributed to suboptimal patient selection and device-related complications. Future strate- gies should focus on individualized treatment approaches, in which therapeutic interventions are closely aligned with the specific shock phenotype and the time-sensitive clinical trajectory of each patient. |
