Key result
Multidisciplinary shock teams linked to ~28% lower odds of CICU mortality.
Why the study?
Single-center studies suggested that multidisciplinary cardiogenic shock teams improve survival, but multicenter practice patterns and outcomes were not characterized.
Does management in centers with multidisciplinary shock teams reduce CICU mortality in patients with cardiogenic shock?
Observational (n=1,242)
Yes
Does management in centers with multidisciplinary shock teams reduce CICU mortality in patients with cardiogenic shock?
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“We think this is a multifactorial thing—places with shock teams are going to have more awareness of rapidly identifying shock and streamlining the identification and classification of the severity of shock [and then] come up with a plan to provide sufficient but not excessive support as fast as possible. And I think that's the real difference here between the centers.”
“Historically it's been about what device we can put in, and I don't think that's the way to approach shock. I think the more-important focus is for shock as a whole. And I think this changes the mindset of all of us for how we approach a patient in cardiogenic shock.”
Implementation of multidisciplinary cardiogenic shock teams in cardiac ICUs is associated with increased use of invasive hemodynamics, advanced mechanical circulatory support, and significantly lower risk-adjusted mortality.
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.
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Papolos et al. (2021) conducted an observational in Cardiogenic shock (n=1,242). Management in a center with a multidisciplinary cardiogenic shock team vs. Centers without a cardiogenic shock team was evaluated on CICU mortality (OR 0.72, 95% CI 0.55-0.94, p=0.016). Management in centers with multidisciplinary shock teams was associated with lower CICU mortality compared to centers without shock teams (23% vs 29%; adjusted OR 0.72; 95% CI 0.55-0.94; P=0.016).
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