Shock Teams May Improve Outcomes of Patients with Cardiogenic Shock (STOP-CS): a systematic review and meta-analysis

A multidisciplinary team-based approach became one of the main paradigms in health care. Current evidence regarding the efficacy of Shock Teams and related advanced shock care models in cardiogenic shock (CS) comes from observational studies, with limited synthetic data available. We aimed to assess the association between advanced shock care models and short- and mid-term outcomes of CS patients.

This systematic review and meta-analysis (PROSPERO registration: CRD42024581904) were conducted according to the PRISMA 2020 Statement. We included observational studies of at least 25 adult CS patients managed with or without a Shock Team or related advanced shock care models. We searched Embase, Medline Ultimate, PubMed, Scopus, and Web of Science from 01.01.2016 to 13.08.2024. Risk of bias was assessed with the Newcastle-Ottawa Scale. Meta-analyses were performed with a random-effects model. The primary outcome was in-hospital mortality.

Nine studies with a total of 658,708 patients met the inclusion criteria. For medium-term mortality, follow-up ranged from 60 to 365 days. Treatment of patients within the included models was associated with lower in-hospital mortality (OR: 0.81, 95%CI: [0.74, 0.90], p<0.0001, I²=58%), lower intensive care unit mortality (OR: 0.58, 95%CI: [0.43, 0.78], p=0.0004, I²=45%), and lower medium-term mortality (HR: 0.59, 95%CI: [0.48, 0.72], p<0.00001, I²=0%). These associations remained significant in sensitivity analyses, although clinical and methodological heterogeneity persisted.

Advanced shock care models may be associated with improved short- and mid-term outcomes in CS patients including lower in-hospital and medium-term mortality. Prospective studies are needed to confirm these results.