PROTOCOLS AND GUIDELINES 2025-2026 ON THE MANAGEMENT OF CARDIAC SHOCK: FROM ASSESSMENT TO HEMODYNAMIC SUPPORT

Cardiogenic shock is one of the leading causes of mortality in Brazil, as the main causative condition is acute myocardial infarction (AMI), and its management remains a challenge despite advances in therapeutic options.It is caused by severe impairment of myocardial performance, resulting in decreased cardiac output (CO), hypoperfusion and target organ hypoxia.In this context, clinically, it presents as hypotension refractory to volume replacement, with characteristics of hypoperfusion of target organs that require pharmacological or mechanical intervention.AMI accounts for 81% of cases of cardiogenic shock.This article aims to conduct a literature review to report on the 2025 update of the American College of Cardiology (ACC) guidelines, the pharmacological and mechanical therapeutic options cited, and their applicability in practice.The scientific databases used were: Scientific Electronic Library Online (Scielo), National Library of Medicine (NIH), Pub-Med, whose definition was performed by the Health Sciences Descriptors (DeCS) using keywords such as "Cardiogenic Shock," "American College of Cardiology," "Vasoactive Drugs," "Mechanical Circulatory Support Devices," using the Boolean operators AND and OR.Articles used were from 2021 to 2026.The ACC guideline refers to a standardization of institutional care for cardiogenic shock, however, it is a fundamental challenge, in addition to repeated assessment and rapid decision--making.First-line interventions to stabilize patients in cardiogenic shock typically include optimization of volume status and administration of vasoactive and inotropic agents.However, evidence on the selection of medications for circulatory support, complication rates, standardized assessment of medication failure, and treatment goals in cardiogenic shock is limited.Titration of catecholamines to the lowest dose that maintains adequate organ perfusion is advisable to avoid unwanted adrenergic effects.Mechanical circulatory support devices can provide partial or total circulatory support and may have differential effects on myocardial oxygen consumption, reduction of left ventricular (LV) overload, LV wall stress, or coronary artery perfusion, as well as support for right ventricular (RV) or biventricular dominant shock.Although it is the most widely used temporary mechanical circulatory support device in many centers, few data demonstrate a clinical or hemodynamic benefit of intra-aortic balloon pump in cardiogenic shock.It can be concluded that early application of mechanical circulatory support in stages A-B in the 2025 ACC guideline reduces mortality, but requires more precise studies of the target population and inclusion of other types of cardiogenic shock.Among the most commonly used vasoactive drugs mentioned were norepinephrine, dobutamine, and epinephrine.