Prospective validation of the SCAI shock classification: Single center analysis

Figures

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  FIGURE 1. SCAI Shock Stage Classification Pyramid. The SCAI Shock stages are illustrated in this figure which is from the SCAI Shock Center website. It illustrates the stages from A to E, with a pyramid structure reflecting that the number of patients is highest in stage A (at risk) and lowest at the extremes (extremis patients). Used with permission from SCAI (Copyright of SCAI)—Email confirming permission available on request. SCAI, Society for Cardiac Angiography and Interventions [Color figure can be viewed at wileyonlinelibrary.com]

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  FIGURE 2. Panel A: Sentara Heart Hospital Shock Team Algorithm. The shock team developed a hybrid algorithm as a guide to operations. This is not intended to be utilized in a rigid fashion but rather to emphasize the importance of hemodynamics and matching support strategy to the particular physiologic disturbances, which are noted. Panel B: Flow diagram of patients seen by the Shock Team. The team evaluated 166 patients and the initial consult indicated the SCAI shock stage. As expected, the team did not receive referrals for stage A (“at risk”) patients who were managed by the general cardiology team. The figure illustrates the percentage of patients who went on to receive mechanical circulatory support and which were followed by a noninvasive route. IABP, intra‐aortic balloon pump; SCAI, Society for Cardiac Angiography and Interventions [Color figure can be viewed at wileyonlinelibrary.com]

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  FIGURE 3. Panel A: Survival by SCAI Shock Stage at initial shock team consult. This Kaplan–Meier plot shows a significant difference in the survival of patients according to initial SCAI Shock stage. There were no early deaths with SCAI stage B patients, with improved survival for SCAI C patients compared to the SCAI D and E groups. This illustrates the potent effect of deterioration or extremis states, which carry a very high mortality. Panel B: This Kaplan–Meier plot demonstrates survival of patients according to the change in SCAI Shock stage as assessed prospectively at 24 hr following initial shock team evaluation. Change is described as SCAI Shock stage better, worse or unchanged. Panel C: This Kaplan–Meier plot demonstrates survival of patients according to the change in SCAI Shock stage as assessed prospectively at 24 hr following initial shock team evaluation. Change is quantitated as the improvement or worsening of SCAI stages. SCAI, Society for Cardiac Angiography and Interventions [Color figure can be viewed at wileyonlinelibrary.com]