Cardiogenic shock teams and centres: a contemporary review of multidisciplinary care for cardiogenic shock

Abstract

Cardiogenic shock (CS) portends high morbidity and mortality in the contemporary era. Despite advances in temporary mechanical circulatory supports (MCS), their routine use in CS to improve outcomes has not been established. Delays in diagnosis and timely delivery of care, disparities in accessing adjunct therapies such revascularization or MCS, and lack of a systematic approach to care of CS contribute to the poor outcomes observed in CS patients. There is growing interest for developing a standardized multidisciplinary team-based approach in the management of CS. Recent prospective studies have shown feasibility of CS teams in improving survival across a spectrum of CS presentations. Herein, we will review the rationale for CS teams focusing on evidence supporting its use in streamlining care, optimizing revascularization strategies, and patient identification and MCS selection. The proposed structure and flow of CS teams will be outlined. An in-depth analysis of four recent studies demonstrating improved outcomes with CS teams is presented. Finally, we will explore potential implementation hurdles and future directions in refining and widespread implementation of dedicated cross-specialty CS teams.

Mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock

“…The role of the multidisciplinary shock team is increasingly recognized as a strategy to improve outcomes in patients presenting with CS [101,102]. The complex pathophysiological nature of CS coupled with its sensitivity to time have prompted more centres to adopt the concept of shock teams.…”

Heart Failure-Related Cardiogenic Shock: Pathophysiology, Evaluation and Management Considerations

“…14 Comparative effectiveness data for these metrics in HF-CS is lacking, although PAPi is more commonly used and has more published algorithms. 53 In sum, although contemporary randomized controlled trials are lacking, and residual confounding is possible with current evidence, PAC use may lead to earlier and more accurate identification of the CS phenotype so that drugand device-based therapies may be applied in a tailored fashion. 50 The routine use of early invasive hemodynamics has been advocated as the standard of care in contemporary CS management.…”

Cardiogenic shock centres for optimal care coordination and improving outcomes in cardiogenic shock

“…There is growing interest for developing CS centres and CS teams using a standardized multidisciplinary team‐based approach in the management of CS. The role of CS teams is to facilitate timely diagnosis, appropriate use of invasive haemodynamics, revascularization strategies and implementation of MCS or other advanced therapies 6,7 ( Figure , Table 1 ).…”