An overview of international cardiogenic shock guidelines and application in clinical practice
Bibliographic record
Abstract
PURPOSE OF REVIEW: In this review, we compare central differences in cardiogenic shock recommendations in international clinical practice guidelines, scientific statements, and the strength of the supporting evidence. Furthermore, we discuss their associations with adherence to guidelines in registry studies. RECENT FINDINGS: The evidence base underpinning American Heart Association/American College of Cardiology's and European Society of Cardiology's recommendations for an early invasive approach is relatively strong, but adherence to these recommendations is poor in registry and population-based studies. There is little evidence supporting the use of temporary mechanical circulatory support or pulmonary arterial catherization in cardiogenic shock, and international guidelines provide weak and conflicting recommendations, yet studies show mechanical circulatory support use is rising exponentially while pulmonary arterial catherization use remains low. Guidelines provide conflicting information on the optimal first-line vasoactive agent and norepinephrine remains the most widely used agent. SUMMARY: There are some inconsistencies between individual guideline recommendations, but there are no consistent associations between the strength of underlying evidence, weight of guideline recommendations, and adherence to guidelines in clinical practice. Improved knowledge translation of recommendations with a strong evidence base, together with research efforts to address priority cardiogenic shock research needs, could serve-to-harmonize recommendations and improve patient outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.054 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.003 |
| Bibliometrics | 0.014 | 0.014 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.003 | 0.003 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.007 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".