Four years of expertise in shock team management of cardiogenic shock

Abstract Background Cardiogenic shock (CS) remains a complex and challenging syndrome in clinical management. Despite advancements in pharmacological therapies and mechanical circulatory support (MCS) devices, the prognosis for patients with CS remains poor. A potential strategy to enhance survival outcomes in this high-risk population is the implementation of a multidisciplinary care model, commonly referred to as the "Shock Team" approach. Purpose The objective of this study was to evaluate whether increasing clinical experience of the Shock Team over time is associated with improved outcomes in patients with CS. Methods This study was based on a retrospective and prospective analysis of a patient database from a large academic tertiary care hospital, covering admissions between 2021 and 2024. Patients were managed in accordance with a CS protocol developed by a Shock Team at our institution. The Shock Team consisted of interventional cardiologists, intensive care cardiologists, cardiac surgeons, and anesthesiologists. MCS devices utilized in our center included the intra-aortic balloon pump, Impella CP, Impella 5.5, extracorporeal membrane oxygenation, and various device combinations when left ventricular unloading was indicated. Additionally, the center maintains an active heart transplantation and a long-term left ventricular assist device (LVAD) program. Results During the study period, 349 patients with CS were identified, with 77 cases in 2021, 87 in 2022, 93 in 2023 and 89 in 2024. Acute coronary syndrome was the leading cause of CS, comprising 52.9% of cases, followed by acute decompensated heart failure 27.8% and other etiologies 19.3%. The mean age of the cohort was 66.3 years (± 14.8 years), and 71.3% were male. Among these patients, 19.3% experienced in-hospital cardiac arrest, while 16.3% presented after out-of-hospital cardiac arrest. Upon admission, 36.5% were classified as Society for Cardiovascular Angiography and Intervention class C, 42.3% as class D, and 21.4% as class E. Additionally, 23.6% of patients were transferred from remote centers due to advanced CS. MCS was utilized in 44.1% of cases, primary heart transplantation was performed in 8.2%, and LVAD implantation was performed in 6.3%.A significant improvement in in-hospital mortality was observed over time, with rates decreasing from 75.4% in 2021 to 69.0% in 2022, 44.1% in 2023 and 32.4% in 2024 (p0.001). Notably, mortality in the MCS group improved significantly, declining from 75.0% in 2021 to 50.0% in 2022, 29.4% in 2023, and 32.6% in 2024 (p0.001). Similarly, significant improvement in mortality was observed in the non-MCS group, with rates of 75.6% in 2021, 78.9% in 2022, 52.5% in 2023 and 32.2% in 2024 (p0.001). Conclusions Our results suggest that a standardized multidisciplinary approach incorporating the availability of advanced MCS therapies and heart transplantation may be associated with improved outcomes in patients with CS.Figure 1