Need for a Cardiogenic Shock Team Collaborative-Promoting a Team-Based Model of Care to Improve Outcomes and Identify Best Practices

Abstract

Cardiogenic shock continues to carry a high mortality rate despite contemporary care, with no breakthrough therapies shown to improve survival over the past few decades. It is a time-sensitive condition that commonly results in cardiovascular complications and multisystem organ failure, necessitating multidisciplinary expertise. Managing patients with cardiogenic shock remains challenging even in well-resourced settings, and an important subgroup of patients may require cardiac replacement therapy. As a result, the idea of leveraging the collective cognitive and procedural proficiencies of multiple providers in a collaborative, team-based approach to care (the "shock team") has been advocated by professional societies and implemented at select high-volume clinical centers. A slowly maturing evidence base has suggested that cardiogenic shock teams may improve patient outcomes. Although several registries exist that are beginning to inform care, particularly around therapeutic strategies of pharmacologic and mechanical circulatory support, none of these are currently focused on the shock team approach, multispecialty partnership, education, or process improvement. We propose the creation of a Cardiogenic Shock Team Collaborative-akin to the successful Pulmonary Embolism Response Team Consortium-with a goal to promote sharing of care protocols, education of stakeholders, and discovery of how process and performance may influence patient outcomes, quality, resource consumption, and costs of care.

Keywords: cardiogenic shock; education; multidisciplinary teams; process improvement.

Figure 1. Cycle of clinical decompensation characterizing the patient with cardiogenic shock.

Figure 2. Key members of an institution's cardiogenic shock team and critical partnerships necessary for establishing and supporting a cardiogenic shock team collaborative.

CICU indicates cardiac intensive care unit; and EMS, emergency medical services.

Figure 3. Important lessons learned from 3 vanguard cardiogenic shock team‐based programs—Inova Heart and Vascular, University of Utah, and University of Ottawa.

CVICU indicates cardiovascular intensive care unit; and MCS, mechanical circulatory support.

Figure 4. Mission, goals, and potential deliverables of a proposed cardiogenic shock team collaborative.