Intensive Care Medicine

, Volume 42, Issue 2, pp 147–163 | Cite as

Acute heart failure and cardiogenic shock: a multidisciplinary practical guidance

  • A. Mebazaa
  • H. Tolppanen
  • C. Mueller
  • J. Lassus
  • S. DiSomma
  • G. Baksyte
  • M. Cecconi
  • D. J. Choi
  • A. Cohen Solal
  • M. Christ
  • J. Masip
  • M. Arrigo
  • S. Nouira
  • D. Ojji
  • F. Peacock
  • M. Richards
  • N. Sato
  • K. Sliwa
  • J. Spinar
  • H. Thiele
  • M. B. Yilmaz
  • J. Januzzi



Acute heart failure (AHF) causes high burden of mortality, morbidity, and repeated hospitalizations worldwide. This guidance paper describes the tailored treatment approaches of different clinical scenarios of AHF and CS, focusing on the needs of professionals working in intensive care settings.


Tissue congestion and hypoperfusion are the two leading mechanisms of end-organ injury and dysfunction, which are associated with worse outcome in AHF. Diagnosis of AHF is based on clinical assessment, measurement of natriuretic peptides, and imaging modalities. Simultaneously, emphasis should be given in rapidly identifying the underlying trigger of AHF and assessing severity of AHF, as well as in recognizing end-organ injuries. Early initiation of effective treatment is associated with superior outcomes. Oxygen, diuretics, and vasodilators are the key therapies for the initial treatment of AHF. In case of respiratory distress, non-invasive ventilation with pressure support should be promptly started. In patients with severe forms of AHF with cardiogenic shock (CS), inotropes are recommended to achieve hemodynamic stability and restore tissue perfusion. In refractory CS, when hemodynamic stabilization is not achieved, the use of mechanical support with assist devices should be considered early, before the development of irreversible end-organ injuries.


A multidisciplinary approach along the entire patient journey from pre-hospital care to hospital discharge is needed to ensure early recognition, risk stratification, and the benefit of available therapies. Medical management should be planned according to the underlying mechanisms of various clinical scenarios of AHF.


Heart failure Cardiogenic shock Emergency Treatment 



The work of G. Baksyte was supported by the grant MIP-049/2015 from the Research Council of Lithuania.

Compliance with ethical standards

Conflicts of interest

A. Mebazaa received speaker’s honoraria from The Medicines Company, Novartis, Orion, Servier, Vifor Pharma, and fee as member of advisory board and/or Steering Committee from Cardiorentis, The Medicine Company, Adrenomed and Critical Diagnostics.

J. Lassus has received consulting and speaker’s honoraria from Bayer, Boeringer Ingelheim, Novartis, Orion Pharma, Pfizer, ResMed, Roche Diagnostics, Servier and Vifor Pharma.

W.F. Peacock received research grants from Abbott, Alere, Banyan, Cardiorentis, Janssen, Portola, Pfizer, Roche, The Medicine’s Company and consultant fees from Alere, Cardiorentis, Janssen, Alere, Cardiorentis, and Janssen. W.F. Peacock has Ownerships in Comprehensive Research Associates LLC, Emergencies in Medicine LLC.

M.B. Yilmaz received research fee from Novartis and Cardiorentis.

A. Cohen Solal received speaker and consulting fees from Actelion, Ipsen, Sorin, Abbott, Novartis, Thermofisher, Alere, Pfizer, Vifor, Amgen, Servier, Bayer, Sanofi, and Boehringer Ingelheim.

M. Christ has received grants for clinical studies and speaking honoraria by Novartis GmbH, Alere GmbH and Roche Diagnostics, Germany.

J. Januzzi has received grants from Thermo-Fisher, Prevencio, Siemens, and Singulex; consulting fees from Novartis, Critical Diagnostics, Radiometer, diaDexus.

CEC; and fees for data and safety monitoring board (DSMB): Novartis, Amgen, Boeringer-Ingelheim.

Other co-authors have no conflict of interests.


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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2015

Authors and Affiliations

  • A. Mebazaa
    • 1
    • 2
    • 3
  • H. Tolppanen
    • 1
    • 4
  • C. Mueller
    • 5
  • J. Lassus
    • 4
  • S. DiSomma
    • 6
  • G. Baksyte
    • 7
  • M. Cecconi
    • 8
  • D. J. Choi
    • 9
  • A. Cohen Solal
    • 1
    • 2
    • 10
  • M. Christ
    • 11
  • J. Masip
    • 12
  • M. Arrigo
    • 1
  • S. Nouira
    • 13
  • D. Ojji
    • 14
  • F. Peacock
    • 15
  • M. Richards
    • 16
  • N. Sato
    • 17
  • K. Sliwa
    • 18
  • J. Spinar
    • 19
  • H. Thiele
    • 20
  • M. B. Yilmaz
    • 21
  • J. Januzzi
    • 22
  1. 1.U 942 InsermParisFrance
  2. 2.University Paris Diderot, Sorbonne Paris CitéParisFrance
  3. 3.Department of Anesthesia and Critical CareHôpital Lariboisière, APHPParisFrance
  4. 4.Heart and Lung CenterHelsinki University Central HospitalHelsinkiFinland
  5. 5.Department of Cardiology and Cardiovascular Research Institute Basel (CRIB)University Hospital BaselBaselSwitzerland
  6. 6.Department of Medical Sciences and Translational MedicineUniversity of Rome Sapienza, Sant’Andrea HospitalRomeItaly
  7. 7.Department of CardiologyKaunas University of MedicineKaunasLithuania
  8. 8.Anaesthesia and Intensive Care, St George’s Hospital and Medical SchoolLondonUK
  9. 9.Department of Internal MedicineSeoul National University Bundang HospitalSeongnamKorea
  10. 10.Department of CardiologyHôpital Lariboisiere, APHPParisFrance
  11. 11.Department of Emergency and Intensive Care MedicineParacelsus Medical UniversityNurembergGermany
  12. 12.Department of Intensive Care MedicineConsorci Sanitari Integral, University of BarcelonaBarcelonaSpain
  13. 13.Emergency Department and Research Unit UR06SP21Fattouma Bourguiba University HospitalMonastirTunisia
  14. 14.Cardiology Unit, Department of MedicineUniversity of Abuja Teaching HospitalAbujaNigeria
  15. 15.Department of Emergency MedicineBaylor College of MedicineBostonUSA
  16. 16.Christchurch Cardioendocrine Research Group, Christchurch HospitalChristchurchNew Zealand
  17. 17.Internal Medicine, Cardiology, and Intensive Care UnitNippon Medical School Musashi-Kosugi HospitalKawasakiJapan
  18. 18.Faculty of Health SciencesHatter Institute for Cardiovascular Research in Africa and IIDMM, University of Cape TownCape TownSouth Africa
  19. 19.Department of Cardiovascular DiseaseInternational Clinical Research Center, University Hospital BrnoBrnoCzech Republic
  20. 20.Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine)University Heart Centre Luebeck, University Hospital Schleswig-HolsteinLübeckGermany
  21. 21.Department of CardiologyCumhuriyet University School of MedicineSivasTurkey
  22. 22.Division of CardiologyMassachusetts General HospitalBostonUSA

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