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    Interventional procedure overview of surgical insertion of a catheter-based intravascular microaxial flow pump for cardiogenic shock

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    Clinical assessment tools

    SCAI SHOCK classification

    The SCAI SHOCK classification uses 5 categories (A to E) to indicate the severity of cardiogenic shock:

    • A (at risk) - haemodynamically stable patient not experiencing symptoms of cardiogenic shock, but at risk for its development

    • B (beginning cardiogenic shock) - clinical evidence of haemodynamic instability without evidence of hypoperfusion

    • C (classic cardiogenic shock) - clinical evidence of hypoperfusion that requires pharmacological or mechanical support

    • D (deteriorating) - clinical evidence of shock that worsens or fails to improve despite therapy escalation

    • E (extremis) - refractory shock or actual or impending circulatory collapse.

    Since this classification was devised the SCAI-CSWG has proposed a modified classification with formal criteria for each stage. In this version, stage B is defined as having either hypoperfusion or hypotension without the need for drug or device therapy. Stage C is defined as having hypoperfusion and hypotension using the same criteria as for SCAI stage B or having treatment for cardiogenic shock with 1 drug (vasopressor or inotrope) or 1 circulatory support device.

    Karnofsky Performance Scale Index

    The Karnofsky Performance Scale Index is an assessment tool for functional impairment. It can be used to compare effectiveness of different therapies and to assess the prognosis in individual patients. In most serious illnesses, the lower the Karnofsky score, the worse the likelihood of survival.

    INTERMACS

    INTERMACS profile (IP): this is a 7-profile categorisation for people with advanced heart failure, ranging from IP-1 as the most critical, to IP-7 as the least critical. IP-1 (critical cardiogenic shock), IP-2 (progressive decline on inotropes), IP-3 (stable but inotrope dependent), IP-4 (resting symptoms on oral therapy at home), IP-5 (exertion intolerant), IP-6 (exertion limited), IP-7 (placeholder – living comfortably with meaningful activity limited to mild physical exertion).