Table 4 The three clinical heart failure scenarios and the clinical profiles in each scenario

Precardiotomy heart failure

   Precardiotomy crash and burn

Refractory cardiogenic shock requiring emergent salvage operation: CPR en route to the operating theatre or prior to anaesthesia induction

Refractory cardiogenic shock (STS definition SBP <80 mmHg and/or CI <1.8 L/minute/m² despite maximal treatment) requiring emergency operation due to ongoing, refractory (difficult, complicated, and/or unmanageable) unrelenting cardiac compromise resulting in life threatening haemodynamic compromise

   Precardiotomy deteriorating fast

Deteriorating haemodynamic instability: increasing doses of intravenous inotropes and/or IABP necessary to maintain SBP > 80 mmHg and/or CI >1.8 L/minute/m². Progressive deterioration. Emergency operation required due to ongoing, refractory (difficult, complicated, and/or unmanageable) unrelenting cardiac compromise, resulting in severe haemodynamic compromise

   Precardiotomy stable on inotropes

Inotrope dependency: intravenous inotropes and/or IABP are necessary to maintain SBP >80 mmHg and/or CI >1.8 L/minute/m² without clinical improvement. Failure to wean from inotropes (decreasing inotropes results in symptomatic hypotension or organ dysfunction). Urgent operation is required

Failure to wean from CPB

   Failure to wean from CPB

Cardiac arrest after prolonged weaning time (>1 hour)

   Deteriorating fast on withdrawal from CPB

Deteriorating haemodynamic instability on withdrawal of CBP after prolonged weaning time (>1 hour)

Increasing doses of intravenous inotropes and/or IABP necessary to maintain SBP >80 mmHg and/or CI >1.8 L/minute/m²

   Stable but inotrope dependent on withdrawal from CPB

Inotrope dependency on withdrawal of CBP after weaning time >30 minutes. Intravenous inotropes and/or IABP are necessary to maintain SBP >80 mmHg and/or CI >1.8 L/minute/m² without clinical improvement

The high incidence of complications after VAD implantation is directly related to prolonged attempted weaning periods from CPB. Application of IABP within 30 minutes from the first attempt to wean from CPB and mechanical circulatory support within 1 hour from the first attempts to wean from the CPB are suggested [90]

Postcardiotomy cardiogenic shock

   Postcardiotomy crash and burn

Cardiac arrest requiring CPR until intervention

Refractory cardiogenic shock (SBP <80 mmHg and/or CI <1.8 L/minute/m², critical organ hypoperfusion with systemic acidosis and/or increasing lactate levels despite maximal treatment, including inotropes and IABP) resulting in life threatening haemodynamic compromise. Emergency salvage intervention required

   Postcardiotomy deteriorating fast

Deteriorating haemodynamic instability. Increasing doses of intravenous inotropes and/or IABP necessary to maintain SBP >80 mmHg and/or CI >1.8 L/minute/m². Progressive deterioration, worsening acidosis and increasing lactate levels. Emergent intervention required due to ongoing, refractory unrelenting cardiac compromise, resulting in severe haemodynamic compromise

   Postcardiotomy stable on inotropes

Inotrope dependency: intravenous inotropes and/or IABP necessary to maintain SBP >80 mmHg and/or CI >1.8 L/minute/m² without clinical improvement. Failure to decrease inotropic support