Clinical Research Directory

Inclusion Criteria: * All of the following are required for inclusion following screening: * Willing to provide informed consent or appropriate consent from a nominated consultee or personal consultee * Presentation within 24 hours of onset of ACS symptoms. * CS can only be secondary to ACS (Type 1 MI STEMI or N-STEMI) or myocarditis * Planned or completed revascularisation of culprit coronary artery CS will be defined by: * Systolic blood pressure \<90 mmHg for at least 30 minutes * A requirement for a continuous infusion of vasopressor or inotropic therapy to maintain systolic blood pressure \> 90 mmHg. * Clinical signs of pulmonary congestion, plus signs of impaired organ perfusion with at least one of the following manifestations: * altered mental status. * cold and clammy skin and limbs. * oliguria with a urine output of less than 30 ml per hour. * elevated arterial lactate level of \>2.0 mmol per litre. Exclusion Criteria: * Any of the inclusion criteria not met and: 1. Unwilling to provide informed consent. 2. Echocardiographic evidence (recorded within 90 mins of end of PCI procedure) of mechanical cause for CS: eg ventricular septal defect, LV-free wall rupture, ischaemic mitral regurgitation. 3. Age \<18 and ≥80 years. 4. Shock from another cause (sepsis, haemorrhagic/hypovolaemic shock, anaphylaxis, etc). 5. Significant systemic illness 6. Known dementia of any severity 7. Comorbidity with life expectancy \<12 months. 8. Out-of-hospital cardiac arrest (OHCA) and any of the following: 1. No return of spontaneous circulation (ongoing resuscitation effort) 2. pH \<7 3. Without bystander CPR within 10 minutes of collapse 9. Arterial lactate level of \<2.0 mmol per litre.