Management and Outcomes of Cardiogenic Shock in Cardiac ICUs With Versus Without Shock Teams

Alexander I Papolos; Benjamin B Kenigsberg; David D Berg; Carlos L Alviar; Erin Bohula; James A Burke; Anthony P Carnicelli; Sunit-Preet Chaudhry; Stavros Drakos; Daniel A Gerber; Jianping Guo; James M Horowitz; Jason N Katz; Ellen C Keeley; Thomas S Metkus; Jose Nativi-Nicolau; Jeffrey R Snell; Shashank S Sinha; Wayne J Tymchak; Sean Van Diepen; David A Morrow; Christopher F Barnett; Critical Care Cardiology Trials Network Investigators

doi:10.1016/j.jacc.2021.07.044

Management and Outcomes of Cardiogenic Shock in Cardiac ICUs With Versus Without Shock Teams

J Am Coll Cardiol. 2021 Sep 28;78(13):1309-1317. doi: 10.1016/j.jacc.2021.07.044.

Authors

Alexander I Papolos¹, Benjamin B Kenigsberg², David D Berg³, Carlos L Alviar⁴, Erin Bohula³, James A Burke⁵, Anthony P Carnicelli⁶, Sunit-Preet Chaudhry⁷, Stavros Drakos⁸, Daniel A Gerber⁹, Jianping Guo³, James M Horowitz⁴, Jason N Katz⁶, Ellen C Keeley¹⁰, Thomas S Metkus¹¹, Jose Nativi-Nicolau⁸, Jeffrey R Snell¹², Shashank S Sinha¹³, Wayne J Tymchak¹⁴, Sean Van Diepen¹⁴, David A Morrow³, Christopher F Barnett²; Critical Care Cardiology Trials Network Investigators

Affiliations

¹ Departments of Cardiology and Critical Care, MedStar Washington Hospital Center, Washington, DC, USA. Electronic address: Alexander.Papolos@Medstar.net.
² Departments of Cardiology and Critical Care, MedStar Washington Hospital Center, Washington, DC, USA.
³ TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁴ The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York, USA.
⁵ Lehigh Valley Heart Institute, Allentown, Pennsylvania, USA.
⁶ Department of Medicine, Duke University Hospital, Durham, North Carolina, USA.
⁷ Department of Medicine, St Vincent Heart Center, Indianapolis, Indiana, USA.
⁸ Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, Utah, USA.
⁹ Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
¹⁰ Department of Medicine University of Florida Gainesville, Gainesville, Florida, USA.
¹¹ Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
¹² Department of Internal Medicine, Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA.
¹³ Inova Heart and Vascular Institute, Inova Fairfax Medical Center, Falls Church, Virginia, USA.
¹⁴ Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.

PMID: 34556316
DOI: 10.1016/j.jacc.2021.07.044

Abstract

Background: Single-center studies suggest that implementation of multidisciplinary cardiogenic shock (CS) teams is associated with improved CS survival.

Objectives: The aim was to characterize practice patterns and outcomes in the management of CS across multiple centers with versus without shock teams.

Methods: The Critical Care Cardiology Trials Network is a multicenter network of cardiac intensive care units (CICUs) in North America. All consecutive medical admissions to each CICU (n = 24) were captured during annual 2-month collection periods (2017-2019; n = 6,872). Shock management and CICU mortality among centers with versus without shock teams were compared using inverse probability weighting.

Results: Ten of the 24 centers had shock teams. Among 1,242 CS admissions, 44% were at shock team centers. The groups were well-balanced with respect to demographics, shock etiology, Sequential Organ Failure Assessment score, biochemical markers of end organ dysfunction, and invasive hemodynamics. Centers with shock teams used more pulmonary artery catheters (60% vs 49%; adjusted odds ratio [OR]: 1.86; 95% CI: 1.47-2.35; P < 0.001), less overall mechanical circulatory support (MCS) (35% vs 43%; adjusted OR: 0.74; 95% CI: 0.59-0.95; P = 0.016), and more advanced types of MCS (53% vs 43% of all MCS; adjusted OR: 1.73; 95% CI: 1.19-2.51; P = 0.005) rather than intra-aortic balloon pumps. The presence of a shock team was independently associated with lower CICU mortality (23% vs 29%; adjusted OR: 0.72; 95% CI: 0.55-0.94; P = 0.016).

Conclusions: In this multicenter observational study, centers with shock teams were more likely to obtain invasive hemodynamics, use advanced types of MCS, and have lower risk-adjusted mortality. A standardized multidisciplinary shock team approach may improve outcomes in CS.

Keywords: cardiac intensive care unit; cardiogenic shock; mechanical circulatory support; pulmonary artery catheter; shock team.

Publication types

Comparative Study
Multicenter Study

MeSH terms

Aged
Coronary Care Units / statistics & numerical data*
Female
Hospital Rapid Response Team / statistics & numerical data*
Humans
Male
Middle Aged
North America / epidemiology
Registries*
Shock, Cardiogenic / mortality*
Shock, Cardiogenic / therapy