ICU / Critical Cardiovascular Care Scores

SCAI Cardiogenic Shock Classification Tool

Clinical calculation support · Verify results before clinical use

Clinical Staging Assessment

Select the current clinical findings and support requirements. Assess the patient at the time of evaluation.

— Current stage
This tool supports clinical assignment of SCAI SHOCK stages A–E. It is not a point score: staging requires integration of bedside findings, biochemical markers, hemodynamics, treatment response, and clinical judgement. Select all findings that apply.
1

Cardiovascular risk context

Is there an acute cardiovascular condition that places the patient at risk of cardiogenic shock?

2

Hemodynamic instability

Select any applicable finding. These findings may support Stage B when systemic perfusion is preserved.

3

Evidence of hypoperfusion

Select any applicable clinical, biochemical, or hemodynamic manifestation of impaired tissue perfusion.

4

Initial intervention and response

Interventions beyond volume resuscitation and subsequent response help distinguish Stages C and D.

5

Extremis / circulatory collapse

Select if the patient has actual or impending cardiovascular collapse.

6

Cardiac arrest modifier

The 2022 update reserves the A modifier for cardiac arrest with persistent impaired neurologic responsiveness (not a brief arrest with rapid neurologic recovery).

—SCAI stage
Classification result
Complete the assessment
Select the relevant clinical findings to generate a suggested stage.
Clinical interpretation

The SCAI SHOCK classification is a clinical severity framework, not a mortality calculator or treatment protocol.

Reassess the stage as the clinical condition and response to therapy evolve.

About the SCAI SHOCK Classification

The Society for Cardiovascular Angiography and Interventions (SCAI) SHOCK classification provides a standardized framework for describing the severity of cardiogenic shock in adults. The stages range from patients at risk (Stage A) to those with extremis and actual or impending circulatory collapse (Stage E).

The 2022 expert consensus update incorporates validation studies and refines the clinical, biochemical, and hemodynamic descriptors. It emphasizes dynamic reassessment and the distinction between shock severity and overall mortality risk.

Stage descriptors

StageDescriptorCore clinical concept
AAt riskAt risk for cardiogenic shock, without current signs or symptoms of shock.
BBeginningHemodynamic instability without hypoperfusion (pre-shock).
CClassicHypoperfusion requiring an intervention beyond volume resuscitation.
DDeterioratingFailure of initial support to restore perfusion; worsening or escalating support.
EExtremisActual or impending circulatory collapse, often with ongoing resuscitation.

Important clinical considerations

  • Stage B is distinguished from Stage C by the presence of hypoperfusion; hypotension alone does not establish classic cardiogenic shock.
  • Stage C generally requires hypoperfusion and at least one pharmacological or mechanical intervention beyond volume resuscitation.
  • Stage D requires failure of an initial support strategy. An element of time and reassessment is necessary; worsening despite therapy is central to this stage.
  • Stage E may result from catastrophic deterioration from any lower stage.
  • The lactate threshold of ≥2 mmol/L supports recognition of hypoperfusion but must be interpreted in context; normal lactate does not exclude hypoperfusion.
  • Invasive hemodynamics, when available, and bedside examination should be integrated rather than treated as isolated mandatory checkboxes.

References

Naidu SS, Baran DA, Jentzer JC, et al. SCAI SHOCK Stage Classification Expert Consensus Update: A Review and Incorporation of Validation Studies. Journal of the Society for Cardiovascular Angiography & Interventions. 2022;1(1):100008.
DOI: 10.1016/j.jscai.2021.100008
Baran DA, Grines CL, Bailey S, et al. SCAI clinical expert consensus statement on the classification of cardiogenic shock. Catheterization and Cardiovascular Interventions. 2019;94(1):29–37.
DOI: 10.1002/ccd.28329
Jentzer JC, van Diepen S, Barsness GW, et al. Cardiogenic Shock Classification to Predict Mortality in the Cardiac Intensive Care Unit. Journal of the American College of Cardiology. 2019;74(17):2117–2128.
DOI: 10.1016/j.jacc.2019.07.077
Society for Cardiovascular Angiography & Interventions. Simple Steps for SCAI SHOCK Staging: Approach to Identifying Early SCAI SHOCK. Official SCAI quality improvement resource.
Official PDF resource
Clinical disclaimer: This tool is intended for educational and clinical decision-support purposes for healthcare professionals. It does not replace comprehensive bedside assessment, hemodynamic evaluation, institutional shock protocols, or specialist consultation. SCAI stage is a measure of shock severity and should not be interpreted as an individualized mortality probability or a stand-alone treatment recommendation. Use clinical judgement and reassess serially.
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