Centers with cardiogenic shock (CS) teams have lower adjusted mortality risk than those without such teams. They also use significantly more pulmonary artery catheters and are more likely to use advanced types of mechanical circulatory support (MCS) devices. These were among the findings of research recently published in the Journal of the American College of Cardiology.
Cardiogenic shock teams were developed to facilitate early shock recognition and expedite multidisciplinary discussions about evaluation and management, including the need for timely MCS and appropriate device selection when indicated.
In this study, researcher sought to characterize practice patterns and outcomes in CS management across multiple centers with and without CS teams using data from the Critical Care Cardiology Trials Network, which includes multiple North American cardiac intensive care units (ICUs). A total of 24 participating centers contributed data consisting of 2-month “snapshots” of consecutive medical admissions to their cardiac ICUs (n=6872) for 2017 and 2018. The researchers compared centers with and without shock teams with regard to their management of shock and cardiac ICU mortality.
In the network, 10 out of the 24 centers had shock teams. Approximately 44% of the 1242 CS admissions were reported at the centers with shock teams. No significant differences were found between centers with and without shock teams with respect to general demographics, shock etiology, Sequential Organ Failure Assessment score, biochemical markers of end organ dysfunction, or invasive hemodynamics.
Centers that had shock teams used significantly more pulmonary artery catheters (60% vs 49%; adjusted odds ratio [OR], 1.86; 95% CI, 1.47-2.35; P <0.001), which were usually placed in half the time (0.3 vs 0.66 days; P =.019). Centers with CS teams also had less overall MCS use (35% vs 43% of CS cases; adjusted OR, 0.74; 95% CI, 0.59-0.95; P =.016), more advanced MCS overall (53% vs 43% of all MCS; adjusted OR, 1.73; 95% CI, 1.19-2.51; P =.005), and more commonly chose advanced types of MCS as their initial device (42% vs 28% of CS patients who received MCS; P =.002). In the inverse probability weighted adjusted analysis, the presence of shock teams at participating centers was independently associated with a significantly lower cardiac ICU mortality (23% vs 29%; adjusted OR, 0.72; 95% CI, 0.55-0.94; P =.016).
A limitation of this study included its observational design, which the investigators suggest may have increased the likelihood of residual confounding. Also, the registry used in the study did not capture patients with CS who did not receive management in the cardiac ICU, which may limit the generalizability of the findings.
Researchers concluded that “A standardized multidisciplinary shock team approach may improve outcomes in CS.”
Papolos AI, Kenigsberg BB, Berg DD, et al; Critical Care Cardiology Trials Network Investigators. Management and outcomes of cardiogenic shock in cardiac ICUs with versus without shock teams. J Am Coll Cardiol. 2021;78(13):1309-1317. doi:10.1016/j.jacc.2021.07.044