Current Practice in Post-Cardiac Surgery Shock: A European Association of Cardiothoracic Anesthesiology and Intensive Care Survey

Abstract

OBJECTIVES: Assessment of clinician-reported incidence, management strategies, and outcomes of post-cardiac surgery shock states (vasoplegic syndrome [VPS] and cardiogenic shock). DESIGN: A 25-question survey of perioperative cardiac clinicians. SETTING: Online survey (5 May through 5 June 2025). PARTICIPANTS: Registered members of the European Association of Cardiothoracic Anaesthesiology and Intensive Care. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Responses were received from clinicians at 63 centers, with representation of 13% of European centers. Median clinician-reported incidence of post-cardiac surgery cardiogenic shock was 5% (95% confidence interval [CI] 5%-8%), and reported use of temporary mechanical circulatory support devices was 2% (95% CI 2%-3%). Intraaortic balloon pump (94%) and venoarterial extracorporeal membrane oxygenation (92%) support were available in almost all centers, whereas transvalvular microaxial flow pump (57%) and ventricular assist device (41%) support were available in fewer institutions. Median clinician-reported VPS incidence was 9% (95% CI 5%-10%), with highly variable provision of different intravenous therapies. All centers were able to use norepinephrine, 89% (n = 56) used vasopressin, and only 13% (n = 8) used angiotensin II. Institutional protocols for the management of cardiogenic shock are used in 27% (n = 17) of centers and in 38% (n = 24) for VPS. CONCLUSION: Cardiogenic shock requiring temporary mechanical circulatory support and VPS affect a significant proportion of patients in the responding clinicians' centers. However, there is a highly variable provision of therapeutic options, and the majority of respondents do not report evidence-based management protocols in their center. An international observation study will be necessary to further elucidate current practice, risk factors, and clinical outcomes in these vulnerable patients with post-cardiac surgery shock states.