Clinical Research Directory

Inclusion Criteria: 1. Aged ≥18 years 2. Cardiogenic shock state, according to the consensual definition: 1. Systemic arterial hypertension (systolic blood pressure \<90 mmHg or mean arterial pressure ≤ 65 mmHg) or signs of peripheral hypoperfusion, requiring treatment with catecholamines to maintain systolic blood pressure ≥ 90 mmHg and regression of signs of hypoperfusion; 2. Presence of at least one sign of systemic hypoperfusion among the following: marbling, oliguria ≤ 25 ml / h, impairment of consciousness, arterial hyperlactatemia\> 2 mmol / L; 3. Presence of at least one sign of hypocontractility or low flow among the following: cardiac index ≤ 2.2 L / min / m2, left ventricular ejection fraction (LVEF) ≤ 40% or full time velocity (ITV) under aortic ≤ 18 cm, or need for catecholamines to maintain an index 4. Clinical signs of left and / or right cardiac congestion (clinical sign of acute cardiogenic pulmonary edema or jugular turgor or edema of the lower limbs), radiological (bilateral alveolar opacities compatible with acute cardiogenic pulmonary edema), echocardiography (elevation of filling pressures of the left ventricle measured with Doppler: E / A\> 2 if LVEF ≤40% or E / Ea\> 13 if LVEF\> 40%; or estimated PAPS\> 35mmHg) or with right cardiac catheterization (pulmonary artery occlusion pressures\> 15mmHg or PAPm\> 25mmHg) 3. Having received informed information about the study and having signed a consent to participate in the study 4. Benefiting from a social security Exclusion Criteria: 1. Cardiogenic shock state with catecholamine infusion for more than 24 hours; 2. Presence Presence of septic shock at inclusion; 3. Cardiopulmonary arrest recovered in the 7 days preceding inclusion with at least one early sign of poor prognosis among the following: no control, non-shockable rhythm, CAHP score (Cardiac Arrest Hospital Prognosis)\> 150; 4. Patients already on circulatory support (ECMO) before inclusion (patients who are assisted after inclusion will not be excluded); 5. Cardiogenic shock on viral myocarditis; 6. Prior corticosteroid therapy (≥ 30 mg prednisone or equivalent ≥ 1 month); 7. Receiving one of the following treatments: ketoconazole, rifampicin, phenytoin, phenobarbital, cyclosporine and clarithromycin; 8. Known history of hypersensitivity to fludrocortisone or hydrocortisone; 9. Known pregnancy or breastfeeding;