Classification and Outcomes of Cardiogenic Shock in Children

Quick Takes

  • The prevalence of cardiogenic shock (CS) is high, occurring in approximately one out of four pediatric admissions for acute decompensated heart failure (ADHF).
  • CS is a strong predictor of in-hospital mortality (OR, 1.9).
  • Cardiomyopathy (48%) and myocarditis (28%) accounted for the vast majority of cases of CS in patients admitted with ADHF, while patients with congenital heart disease accounted for 9%.

Study Questions:

What are the characteristics and outcomes of cardiogenic shock (CS) in children hospitalized for acute decompensated heart failure (ADHF)?


A retrospective review was performed at a single center. Patients with CS at presentation were analyzed and risk factors for CS and for the primary outcome of in-hospital mortality were identified. A modified Society for Cardiovascular Angiography and Interventions (SCAI) classification was created and used to stage patients.


CS occurred in 207 (26%) of 803 hospitalizations for ADHF in 591 unique patients (median age, 7.6 years). ADHF hospitalizations with CS were characterized by worse systolic function (p = 0.040), higher B-type natriuretic peptide concentration (p = 0.032), and more frequent early severe renal (p = 0.023) and liver (p < 0.001) injury, as compared with those without CS. When analyzing only the most recent ADHF hospitalization, children with CS were at increased risk of in-hospital mortality compared to children without CS (28% vs. 11%; odds ratio [OR], 1.9; 95% confidence interval, 1.1-3.5; p = 0.33). For patients with CS, the etiology of heart failure was cardiomyopathy in 48% of cases, myocarditis in 28%, transplant graft failure in 11%, congenital heart disease in 9%, and others in 8%. Each higher CS stage was associated with greater inpatient mortality (OR, 2.4-8.9; p < 0.001).


The authors conclude that CS occurs in 26% of pediatric hospitalizations for ADHF and is independently associated with hospital mortality. A modified SCAI classification for CS severity showed a strong association with increasing mortality.


This study demonstrated a high rate of mortality in children with CS. The authors present modification of the SCAI classification for CS ranging from Stage A (“At Risk”) to Stage E (“In Extremis,” requiring cardiopulmonary resuscitation). Most patients with CS are patients with structurally normal hearts and cardiomyopathy or myocarditis as opposed to patients with congenital heart disease. This study provides a basis for understanding circulatory shock in children and lays the groundwork for future risk stratification studies to identify patients who would benefit from early use of advanced therapies.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure, Congenital Heart Disease and Pediatric Cardiology

Keywords: Acute Heart Failure, Pediatrics, Shock, Cardiogenic

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