Early recognition of cardiogenic shock: a systematic review of novel and traditional indicators

Cardiogenic shock is one of the most serious complications of acute myocardial infarction (ΑΜΙ) and frequently occurs during hospitalization in coronary care units. Early recognition of cardiogenic shock by nurses allows a faster mobililisation of the medical team and immediate initiation of targeted therapy, thereby reducing mortality and improving prognosis.

Our aim was to collect and analyze clinical signs and objective parameters contributing to differential diagnosis and early recognition of cardiogenic shock.

A systematic review (PRISMA) was performed in PubMed and CINAHL up to November 2025, under the keywords: "cardiogenic shock" AND "early recognition" AND "nursing assessment" AND "hemodynamic monitoring" AND "shock index" OR ("early detection" OR "early diagnosis"). In addition, relevant ESC and AHA guidelines were searched.

This literature review confirmed classic early signs of cardiovenic shock; hypotension (mean arterial pressure-MAP ≤ 65mmHg), tachycardia (heart rate-HR > 100 bpm/minute), cold extremities, reduced urine output and altered mental status combined with haemodynamic parameters such as shock index >0.9, elevated lactate levels and reduced central venous oxygen saturation. Bedside assessment of systemic vascular resistance (SVR) using peripheral temperature and capillary refill time (CRT) emerged as a reliable nursing tool for evaluating tissue perfusion. Recent evidence supports haemodynamic phenotype-guided assessment (warm/cold, wet/dry), allowing early differentiation between low cardiac output states and volume-related congestion. The current guidelines highlight the use of SCAI shock-staging techniques. SCAI, combined with continuous monitoring and perfusion indicators, can help nurses detect early deterioration, guide early escalation of therapy (vasopressors, inotropic medicines), support (MCS-mechanical circulatory support), and prompt activation of the medical team.

Combining new evidence with traditional indicators lead to optimal clinical decision-making. Patients at risk of developing cardiogenic shock may benefit from nurse-led non-invasive assessment. Therefore, continuous monitoring and good interpretation of haemodynamics is essential. Serial SCAI staging improves early detection of deterioration.