The Role of a Cardiogenic Shock Team in Decision Making Surrounding Mechanical Circulatory Support

Cardiogenic shock (CS) confers high mortality rates and remains a challenge for cardiovascular specialists. The difficulty in treating CS lies in its complexity, phenotypic heterogeneity, and the need for expedient treatment. Emerging evidence suggests that cardiogenic shock teams (CS teams), consisting of multiple specialists working in tandem with set protocols and care pathways to offer standardized team-based care, may reduce mortality and morbidity in patients with CS. A key reason for improved outcomes may be the team's decisions surrounding the use of temporary mechanical support devices (tMCS). CS teams expedite the identification of patients who require tMCS and determine the most appropriate device based on patient factors, including shock phenotype. The CS team ensures that tMCS best practices are followed and assists in determining the timing of device escalation or de-escalation. This article will discuss the rationale and role of CS teams. The evidence behind CS teams and their impact on tMCS decision making will be reviewed. Recent trial evidence for the use of tMCS in CS secondary to acute myocardial infarction (AMI) will be examined. Considerations for creating and optimizing an AMI-CS team will be highlighted. Finally, we will examine the current use of CS teams, potential challenges, and future directions for establishing CS teams in Canada.