Cardiogenic shock code 2023. Expert document for a multidisciplinary organization that allows quality care

Area of Science:

• Cardiology
• Critical Care Medicine
• Health Systems Management

Background:

• Prognosis for cardiogenic shock (CS) patients remains poor despite advances in mechanical circulatory support (MCS).
• Existing care models lack the necessary speed and standardization for optimal CS patient outcomes.
• Inspiration drawn from 'infarction code' initiatives highlights the potential for protocolized care.

Purpose of the Study:

• To justify the implementation of a CS code initiative.
• To define the structure, organization, activation criteria, patient flow, and quality indicators for a CS code.
• To address implementation challenges, including pediatric CS care.

Main Methods:

• Multidisciplinary expert consensus and review of previous CS and infarction code experiences.
• Development of a structured protocol for CS patient management, including MCS selection and timing.
• Analysis of logistical and team-based requirements for effective CS code implementation.

Main Results:

• The proposed CS code provides a framework for adequate, rapid, and quality care delivery.
• Detailed guidelines for team structure, logistics, patient management, and MCS utilization are outlined.
• Specific considerations for pediatric CS code implementation are addressed.

Conclusions:

• Protocolized, multidisciplinary, and centralized care in experienced centers is crucial for CS patients.
• Implementing a CS code can minimize inequities in MCS access and improve patient survival.
• Institutional and administrative support is essential for optimizing CS care and CS code success.