Implementation of a Multidisciplinary Cardiogenic Shock Team in a Nonacademic Canadian Heart Centre: An...

Area of Science:

• Cardiology
• Critical Care Medicine

Background:

• Cardiogenic shock (CS) presents a significant challenge in critical care settings.
• Early identification and management are crucial for improving patient outcomes.
• A structured team-based approach (CS-Team) was evaluated for its implementation and impact.

Purpose of the Study:

• To assess the feasibility of implementing a team-based cardiogenic shock (CS-Team) protocol.
• To evaluate the effectiveness of early screening, CS-Team activation, and invasive monitoring in CS management.
• To identify predictors of mortality in patients with CS.

Main Methods:

• A 12-month prospective study screened all coronary care unit (CCU) admissions for CS (hypotension and hypoperfusion).
• The CS-Team comprised CCU attending, interventional cardiologist, and cardiac surgeon.
• Multivariate analysis identified predictors of mortality.

Main Results:

• Screening documented in 74% of admissions; 80 patients (6.9%) had CS (SCAI stages C-E) with higher mortality (35% vs 2%).
• CS-Team activated in 44% of CS patients, leading to increased invasive monitoring (pulmonary artery catheter, cardiac catheterization, mechanical circulatory support).
• CS severity (SCAI D/E) and age predicted mortality; CS-Team activation did not.

Conclusions:

• Early screening for CS is feasible but has limitations.
• CS-Team activation is discretionary and did not directly predict mortality in this study.
• CS-Team activation significantly increased the utilization of invasive monitoring to guide therapy.