In this episode of Saving Lives: Critical Care Conversations, we discuss new evidence from the University of Pennsylvania that challenges how we time inotropic therapy in acute decompensated heart failure–related cardiogenic shock.

This retrospective cohort study found that patients who received inotropes within eight hours of meeting SCAI stage C criteria had a 28-day mortality of 17%, compared to 33% in those who received them later. Early inotrope use was also associated with less vasopressor dependence and quicker access to echocardiography and hemodynamic monitoring.

We’ll explore what this means for emergency and critical care practice—how recognizing hypoperfusion early, even in normotensive patients, may improve survival. We’ll also touch on the role of SCAI and SHARC criteria in timely shock identification and management.

Because in cardiogenic shock, the difference between early and delayed therapy might be the difference between life and death.

The Vasopressor & Inotrope Handbook

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Citation: Greenwood JC, Ratnayake C, Shabbir M, Opitz S, Jang DH, Choi WJ, Panebianco NL, Shofer FS, Augoustides JGT, Bakker J, Wald JW, Abella BS. Timing of inotropic support is associated with mortality in patients with acute decompensated heart failure-associated cardiogenic shock. Intensive Care Med Exp. 2025 Oct 31;13(1):111. doi: 10.1186/s40635-025-00806-z. PMID: 41174190; PMCID: PMC12579036.