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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Cardiogenic Shock: Protocols, Teams, Centers, and Networks
Alex F Warren1,2, Carolyn Rosner3, Raghav Gattani3
1South-East Scotland School of Anaesthesia Edinburgh, UK.
Insights
Improving cardiogenic shock (CS) outcomes requires a coordinated approach. Implementing multidisciplinary shock teams and networked care facilities can reduce mortality and improve patient outcomes.
Area of Science:
- Cardiology
- Critical Care Medicine
- Health Systems Science
Background:
- Cardiogenic shock (CS) continues to have high mortality rates.
- Delays in CS recognition and treatment access contribute to poor outcomes.
- Multidisciplinary 'shock team' approaches are increasingly recommended for CS management.
Purpose of the Study:
- To review the benefits of a networked approach to cardiogenic shock care.
- To discuss team-based and protocolized CS management strategies.
- To explore the potential benefits, challenges, and opportunities of integrated CS care systems.
Main Methods:
- This is a narrative review.
- The review synthesizes existing evidence on CS management strategies.
- It discusses the implementation of 'shock teams' and 'shock networks'.
Main Results:
- A volume-outcome relationship is observed in CS care.
- Networked care models and 'shock hubs' offer opportunities for improved and equitable CS treatment.
- Team-based and protocolized management can enhance patient outcomes.
Conclusions:
- Coordinated, multidisciplinary, and networked approaches are crucial for improving cardiogenic shock outcomes.
- Implementing 'shock teams' and 'shock networks' can address current challenges in CS care.
- Further development of these systems holds promise for reducing CS mortality.
Abstract:
The mortality of cardiogenic shock (CS) remains unacceptably high. Delays in the recognition of CS and access to disease-modifying or hemodynamically stabilizing interventions likely contribute to poor outcomes. In parallel to successful initiatives in other disease states, such as acute ST-elevation MI and major trauma, institutions are increasingly advocating the use of a multidisciplinary 'shock team' approach to CS management. A volume-outcome relationship exists in CS, as with many other acute cardiovascular conditions, and the emergence of 'shock hubs' as experienced facilities with an interest in improving CS outcomes through a hub-and-spoke 'shock network' approach provides another opportunity to deliver improved CS care as widely and equitably as possible. This narrative review outlines improvements from a networked approach to care, discusses a team-based and protocolized approach to CS management, reviews the available evidence and discusses the potential benefits, challenges, and opportunities of such systems of care.
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