Cardiogenic Shock and Mechanical Circulatory Support: Standardization, Selection and Outcomes

Cardiogenic shock remains a major challenge in acute cardiovascular and critical care, with in-hospital mortality approximately 40–50% despite advances in reperfusion, intensive care, and mechanical circulatory support (MCS). Management varies substantially between centres and health systems, particularly in patient selection, timing of support, escalation, monitoring, and weaning. Recent findings from DanGer Shock and ECLS-SHOCK have refined understanding of the potential benefits and risks of temporary MCS, while highlighting persistent uncertainty about which patients benefit, when support should be initiated, and how treatment-related complications can be reduced. Shock teams, SCAI shock-stage classification, haemodynamic phenotyping, and regional care networks offer promising ways to replace ad hoc decisions with standardized, reproducible pathways. However, the implementation, generalizability, and comparative effectiveness of these strategies across aetiologies and resource settings remain insufficiently established.This Research Topic will examine how standardized, cross-aetiology approaches can improve the management of cardiogenic shock across diverse clinical presentations, healthcare systems, and stages of illness. It will focus on translating SCAI-stage classification and haemodynamic phenotyping into consistent pathways for selection, escalation, monitoring, and de-escalation; evaluating how shock teams and regional shock networks perform outside controlled trial environments; and assessing whether protocolized care improves survival, complications, resource utilization, and patient-centred outcomes. It will also consider how MCS should be integrated into care pathways for non-ischaemic shock, including myocarditis, acute decompensated heart failure, and post-cardiotomy failure. The collection will connect clinical decision-making, implementation science, health-system organization, and outcomes research to identify approaches that can be applied across centres and resource settings.We welcome original research, clinical studies, registries, systematic and narrative reviews, methodological papers, and perspectives addressing topics including:• Operationalization and validation of SCAI shock stages and haemodynamic phenotypes• Patient selection and timing of temporary MCS initiation• Shock-team models, referral pathways, and regional shock networks• Standardized escalation, monitoring, weaning, and de-escalation protocols• Comparative outcomes of protocolized versus centre-dependent care• Registry-based and cross-health-system analyses of survival, complications, and resource utilization• Cardiogenic shock associated with acute myocardial infarction, myocarditis, acute decompensated heart failure, and post-cardiotomy failure• MCS implementation in resource-variable and non-tertiary-care settings• Quality metrics, benchmarking, health economics, and equitable access to shock care• Risk prediction, clinical decision support, and prospective implementation studies• Multidisciplinary approaches linking critical care, cardiology, cardiac surgery, perfusion, nursing, and rehabilitation• Longitudinal outcomes following shock-team assessment, temporary support, recovery, escalation, or transition to advanced therapiesWe particularly encourage work that moves beyond single-centre description to compare pathways, test implementation strategies, and clarify how evidence can be translated into reliable, equitable practice. The collection will favour clinically grounded studies that connect MCS decisions with patient selection, haemodynamic goals, team-based care, and outcomes across different causes and stages of cardiogenic shock. Topic editors: Grigoris Karamasis, Krishnaraj Rathod Source: https://www.frontiersin.org/research-topics/85228/cardiogenic-shock-and-mechanical-circulatory-support-standardization-selection-and-outcomes