The Role of PoCUS in the Diagnosis and Early Monitoring of Cardiogenic Shock in the Emergency Department: A Narrative Review.

Cardiogenic shock (CS) is the most serious heart failure manifestation, characterised by a significant risk of morbidity and mortality despite improving diagnosis and treatment: early recognition and accurate hemodynamic phenotypization are crucial to improve its poor prognosis. Recently, point-of-care ultrasound (PoCUS) has evolved as a key method in emergency settings for fast shock assessment. Evidence indicates that PoCUS improves the clinician's diagnostic accuracy by identifying ventricular dysfunction, valvular disease, complications of myocardial infarction, loading conditions, and systemic congestion. Multiorgan protocols that combine cardiac, pulmonary, and vascular assessments enable differentiation among cardiogenic, obstructive, hypovolemic, and distributive shock. Echocardiographic parameters-including ventricular function, volume indices, and dynamic measures such as stroke volume and cardiac output-can guide fluid management, vasoactive therapy, and circulatory support. Limitations include operator dependence and potential imaging challenges due to patient factors. When combined with clinical and laboratory data, PoCUS is a fundamental tool for early CS assessment. With this paper, we aimed to describe the role of PoCUS in the differential diagnosis of undifferentiated shock, confirming or ruling out CS, assessing CS prognosis, guiding appropriate treatment and enabling hemodynamic monitoring. Integrating PoCUS elements with validated classifications, such as the Society for Cardiovascular Angiography and Interventions (SCAI) CS stages, can be useful for improving CS management. This review highlights validated PoCUS markers, practical PoCUS applications within the SCAI framework, and areas for further research, emphasising the increasing role of PoCUS in personalised, physiology-guided management of CS in the emergency department.