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Shock Teams: A Contemporary Review

  • Cardiovascular Critical Care (A Higgins and R Lee, Section Editors)
  • Published:
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Abstract

Purpose of Review

Cardiogenic shock (CS) is a time-sensitive and often fatal condition. To address this issue, many centers have developed multidisciplinary shock teams with a common goal of expediting the recognition and treatment of CS. In this review, we examine the mission, structure, implementation, and outcomes reported by these early shock teams.

Recent Findings

To date, there have been four observational shock team analyses, each providing unique insight into the utility of the shock team.

Summary

The limited available data supports that shock teams are associated with improved CS mortality. However, there is considerable operational heterogeneity among shock teams, and randomized data assessing their value and best practices in both local and regional care models are needed.

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References

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  1. Osman M, Syed M, Patibandla S, Sulaiman S, Kheiri B, Shah MK, et al. Fifteen‐year trends in incidence of cardiogenic shock hospitalization and in‐hospital mortality in the United States. J Am Heart Assoc [Internet]. 2021;10. Available from: https://www.ahajournals.org/doi/10.1161/JAHA.121.021061.

  2. Berg DD, Bohula EA, van Diepen S, Katz JN, Alviar CL, Baird-Zars VM, et al. Epidemiology of shock in contemporary cardiac intensive care units. Circ Cardiovasc Qual Outcomes [Internet]. 2019;12. Available from: https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.119.005618.

  3. Hochman JS, Sleeper LA, Webb JG, Sanborn TA, White HD, Talley JD, et al. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. N Engl J Med [Internet]. 1999;341:625–34. Available from: http://www.nejm.org/doi/abs/10.1056/NEJM199908263410901.

  4. Ouweneel DM, Eriksen E, Sjauw KD, van Dongen IM, Hirsch A, Packer EJS, et al. Percutaneous mechanical circulatory support versus intra-aortic balloon pump in cardiogenic shock after acute myocardial infarction. J Am Coll Cardiol [Internet]. 2017;69:278–87. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0735109716367675.

  5. Thiele H, Zeymer U, Neumann F-J, Ferenc M, Olbrich H-G, Hausleiter J, et al. Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med [Internet]. 2012;367:1287–96. Available from: http://www.nejm.org/doi/10.1056/NEJMoa1208410.

  6. Burkhoff D, O’Neill W, Brunckhorst C, Letts D, Lasorda D, Cohen HA. Feasibility study of the use of the TandemHeart® percutaneous ventricular assist device for treatment of cardiogenic shock. Catheter Cardiovasc Interv [Internet]. 2006;68:211–7. Available from: https://onlinelibrary.wiley.com/doi/10.1002/ccd.20796.

  7. Thiele H, Akin I, Sandri M, de Waha-Thiele S, Meyer-Saraei R, Fuernau G, et al. One-year outcomes after PCI strategies in cardiogenic shock. N Engl J Med [Internet]. 2018;379:1699–710. Available from: http://www.nejm.org/doi/10.1056/NEJMoa1808788.

  8. Kolte D, Khera S, Aronow WS, Mujib M, Palaniswamy C, Sule S, et al. Trends in incidence, management, and outcomes of cardiogenic shock complicating ST‐elevation myocardial infarction in the United States. J Am Heart Assoc [Internet]. 2014;3. Available from: https://www.ahajournals.org/doi/10.1161/JAHA.113.000590.

  9. Harjola V-P, Lassus J, Sionis A, Køber L, Tarvasmäki T, Spinar J, et al. Clinical picture and risk prediction of short-term mortality in cardiogenic shock. Eur J Heart Fail [Internet]. 2015;17:501–9. Available from: https://onlinelibrary.wiley.com/doi/10.1002/ejhf.260.

  10. Baran DA, Grines CL, Bailey S, Burkhoff D, Hall SA, Henry TD, et al. SCAI clinical expert consensus statement on the classification of cardiogenic shock. Catheter Cardiovasc Interv [Internet]. 2019;ccd.28329. Available from: https://onlinelibrary.wiley.com/doi/10.1002/ccd.28329.

  11. Jentzer JC, van Diepen S, Barsness GW, Henry TD, Menon V, Rihal CS, et al. Cardiogenic shock classification to predict mortality in the cardiac intensive care unit. J Am Coll Cardiol [Internet]. 2019;74:2117–28. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0735109719362916.

  12. Naidu SS, Baran DA, Jentzer JC, Hollenberg SM, van Diepen S, Basir MB, et al. SCAI SHOCK Stage Classification Expert Consensus Update: a review and incorporation of validation studies. J Am Coll Cardiol [Internet]. 2022;79:933–46. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0735109722001802.

  13. Jentzer JC, Baran DA. The changing face of cardiogenic shock: definitions, epidemiology, and severity assessment. Curr Opin Crit Care [Internet]. 2023;Publish Ah. Available from: https://journals.lww.com/10.1097/MCC.0000000000001065.

  14. •• Papolos AI, Kenigsberg BB, Berg DD, Alviar CL, Bohula E, Burke JA, et al. Management and outcomes of cardiogenic shock in cardiac ICUs with versus without shock teams. J Am Coll Cardiol [Internet]. 2021;78:1309–17. Available from: https://linkinghub.elsevier.com/retrieve/pii/S073510972105782X. This is the first multicenter study to show that centers with shock teams have improved CS survival.

  15. Basir MB, Schreiber T, Dixon S, Alaswad K, Patel K, Almany S, et al. Feasibility of early mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock: the Detroit cardiogenic shock initiative. Catheter Cardiovasc Interv [Internet]. 2018;91:454–61. Available from: https://onlinelibrary.wiley.com/doi/10.1002/ccd.27427.

  16. Basir MB, Kapur NK, Patel K, Salam MA, Schreiber T, Kaki A, et al. Improved outcomes associated with the use of shock protocols: updates from the National Cardiogenic Shock Initiative. Catheter Cardiovasc Interv [Internet]. 2019;ccd.28307. Available from: https://onlinelibrary.wiley.com/doi/10.1002/ccd.28307.

  17. Doll JA, Ohman EM, Patel MR, Milano CA, Rogers JG, Wohns DH, et al. A team-based approach to patients in cardiogenic shock. Catheter Cardiovasc Interv [Internet]. 2016;88:424–33. Available from: https://onlinelibrary.wiley.com/doi/10.1002/ccd.26297.

  18. Lee F, Hutson JH, Boodhwani M, McDonald B, So D, De Roock S, et al. Multidisciplinary code shock team in cardiogenic shock: a Canadian Centre experience. CJC Open [Internet]. 2020;2:249–57. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2589790X20300330.

  19. Taleb I, Koliopoulou AG, Tandar A, McKellar SH, Tonna JE, Nativi-Nicolau J, et al. Shock team approach in refractory cardiogenic shock requiring short-term mechanical circulatory support. Circulation [Internet]. 2019;140:98–100. Available from: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.119.040654.

  20. Tehrani B, Truesdell A, Singh R, Murphy C, Saulino P. Implementation of a Cardiogenic Shock Team and Clinical Outcomes (INOVA-SHOCK Registry): observational and retrospective study. JMIR Res Protoc [Internet]. 2018;7:e160. Available from: http://www.researchprotocols.org/2018/6/e160/.

  21. Tehrani BN, Truesdell AG, Sherwood MW, Desai S, Tran HA, Epps KC, et al. Standardized team-based care for cardiogenic shock. J Am Coll Cardiol [Internet]. 2019;73:1659–69. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0735109719304954.

  22. • Tehrani BN, Sherwood MW, Rosner C, Truesdell AG, Ben Lee S, Damluji AA, et al. A standardized and regionalized network of care for cardiogenic shock. JACC Hear Fail [Internet]. 2022;10:768–81. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2213177922002426. This study characterizes a sucessful regional hub and spoke shock team model.

  23. Brusca SB, Caughron H, Njoroge JN, Cheng R, O’Brien CG, Barnett CF. The shock team: a multidisciplinary approach to early patient phenotyping and appropriate care escalation in cardiogenic shock. Curr Opin Cardiol [Internet]. 2022;37:241–9. Available from: https://journals.lww.com/10.1097/HCO.0000000000000967.

  24. Dillane C, Bove A, Cohen H, Bashir R, O’Murchu B, O’Neill B, et al. A shock team improves survival in cardiogenic shock by decreasing time to intervention. J Hear Lung Transplant [Internet]. 2016;35:S55. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1053249816001996.

  25. Jacobs AK, Antman EM, Faxon DP, Gregory T, Solis P. Development of systems of care for ST-elevation myocardial infarction patients. Circulation [Internet]. 2007;116:217–30. Available from: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.107.184043.

  26. Jones DA, DeVita MA, Bellomo R. Rapid-Response Teams. N Engl J Med [Internet]. 2011;365:139–46. Available from: http://www.nejm.org/doi/abs/10.1056/NEJMra0910926.

  27. Daghash H, Lim Abdullah K, Ismail MD. The effect of acute coronary syndrome care pathways on in‐hospital patients: a systematic review. J Eval Clin Pract [Internet]. 2020;26:1280–91. Available from: https://onlinelibrary.wiley.com/doi/10.1111/jep.13280.

  28. Morey JR, Zhang X, Marayati NF, Matsoukas S, Fiano E, Oxley T, et al. Mobile interventional stroke teams improve outcomes in the early time window for large vessel occlusion stroke. Stroke [Internet]. 2021;52. Available from: https://www.ahajournals.org/doi/10.1161/STROKEAHA.121.034222.

  29. Kabrhel C, Rosovsky R, Channick R, Jaff MR, Weinberg I, Sundt T, et al. A multidisciplinary pulmonary embolism response team. Chest [Internet]. 2016;150:384–93. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0012369216426310.

  30. Rosovsky R, Zhao K, Sista A, Rivera‐Lebron B, Kabrhel C. Pulmonary embolism response teams: purpose, evidence for efficacy, and future research directions. Res Pract Thromb Haemost [Internet]. 2019;3:315–30. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2475037922016181.

  31. Morrison LJ, Neumar RW, Zimmerman JL, Link MS, Newby LK, McMullan PW, et al. Strategies for improving survival after in-hospital cardiac arrest in the United States: 2013 Consensus Recommendations. Circulation [Internet]. 2013;127:1538–63. Available from: https://www.ahajournals.org/doi/10.1161/CIR.0b013e31828b2770.

  32. Garan AR, Kirtane A, Takayama H. Redesigning care for patients with acute myocardial infarction complicated by cardiogenic shock. JAMA Surg [Internet]. 2016;151:684. Available from: http://archsurg.jamanetwork.com/article.aspx?doi=10.1001/jamasurg.2015.5514.

  33. Fiedler AG, Song TH, D’Alessandro DA. Redesigning care for patients with acute myocardial infarction complicated by cardiogenic shock. JAMA Surg [Internet]. 2016;151:685. Available from: http://archsurg.jamanetwork.com/article.aspx?doi=10.1001/jamasurg.2015.5517.

  34. Truesdell AG, Tehrani B, Singh R, Desai S, Saulino P, Barnett S, et al. ‚‘Combat’ approach to cardiogenic shock. Interv Cardiol Rev [Internet]. 2018;1. Available from: https://www.icrjournal.com/articles/combat-approach-cardiogenic-shock.

  35. Rab T. “Shock Teams” and “Shock Docs.” J Am Coll Cardiol [Internet]. 2019;73:1670–2. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0735109719304966.

  36. Shaefi S, O’Gara B, Kociol RD, Joynt K, Mueller A, Nizamuddin J, et al. Effect of cardiogenic shock hospital volume on mortality in patients with cardiogenic shock. J Am Heart Assoc [Internet]. 2015;4. Available from: https://www.ahajournals.org/doi/10.1161/JAHA.114.001462.

  37. Vallabhajosyula S, Dunlay SM, Barsness GW, Rihal CS, Holmes DR, Prasad A. Hospital-level disparities in the outcomes of acute myocardial infarction with cardiogenic shock. Am J Cardiol [Internet]. 2019;124:491–8. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0002914919306058.

  38. Hannan EL, Wu C, Walford G, King SB, Holmes DR, Ambrose JA, et al. Volume-outcome relationships for percutaneous coronary interventions in the stent era. Circulation [Internet]. 2005;112:1171–9. Available from: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.104.528455.

  39. Ross JS, Normand S-LT, Wang Y, Ko DT, Chen J, Drye EE, et al. Hospital volume and 30-day mortality for three common medical conditions. N Engl J Med [Internet]. 2010;362:1110–8. Available from: http://www.nejm.org/doi/abs/10.1056/NEJMsa0907130.

  40. Harold JG, Bass TA, Bashore TM, Brindis RG, Brush JE, Burke JA, et al. ACCF/AHA/SCAI 2013 update of the clinical competence statement on coronary artery interventional procedures. Circulation [Internet]. 2013;128:436–72. Available from: https://www.ahajournals.org/doi/10.1161/CIR.0b013e318299cd8a.

  41. Alberts MJ, Latchaw RE, Selman WR, Shephard T, Hadley MN, Brass LM, et al. Recommendations for comprehensive stroke centers. Stroke [Internet]. 2005;36:1597–616. Available from: https://www.ahajournals.org/doi/10.1161/01.STR.0000170622.07210.b4.

  42. Celso B, Tepas J, Langland-Orban B, Pracht E, Papa L, Lottenberg L, et al. A systematic review and meta-analysis comparing outcome of severely injured patients treated in trauma centers following the establishment of trauma systems. J Trauma Inj Infect Crit Care [Internet]. 2006;60:371–8. Available from: http://journals.lww.com/00005373-200602000-00020.

  43. Mooney MR, Unger BT, Boland LL, Burke MN, Kebed KY, Graham KJ, et al. Therapeutic hypothermia after out-of-hospital cardiac arrest. Circulation [Internet]. 2011;124:206–14. Available from: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.110.986257.

  44. Henry TD, Sharkey SW, Burke MN, Chavez IJ, Graham KJ, Henry CR, et al. A regional system to provide timely access to percutaneous coronary intervention for ST-elevation myocardial infarction. Circulation [Internet]. 2007;116:721–8. Available from: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.107.694141.

  45. Elrod JK, Fortenberry JL. The hub-and-spoke organization design: an avenue for serving patients well. BMC Health Serv Res [Internet]. 2017;17:457. Available from: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-017-2341-x.

  46. Jollis JG, Al-Khalidi HR, Roettig ML, Berger PB, Corbett CC, Dauerman HL, et al. Regional systems of care demonstration project. Circulation [Internet]. 2016;134:365–74. Available from: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.115.019474.

  47. Huber K, Gersh BJ, Goldstein P, Granger CB, Armstrong PW. The organization, function, and outcomes of ST-elevation myocardial infarction networks worldwide: current state, unmet needs and future directions. Eur Heart J [Internet]. 2014;35:1526–32. Available from: https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehu125.

  48. van Diepen S, Katz JN, Albert NM, Henry TD, Jacobs AK, Kapur NK, et al. Contemporary management of cardiogenic shock: a scientific statement from the American Heart Association. Circulation [Internet]. 2017;136. Available from: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000525.

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  1. Department of Critical Care and Division of Cardiology, MedStar Washington Hospital Center, 110 Irving St NW, Suite 1A-27, Washington, DC, 20010, USA

    Margaret J. Stevenson, Benjamin B. Kenigsberg, Narayana Sarma V. Singam & Alexander I. Papolos

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  1. Margaret J. Stevenson
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  2. Benjamin B. Kenigsberg
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Correspondence to Alexander I. Papolos.

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Stevenson, M.J., Kenigsberg, B.B., Singam, N.S.V. et al. Shock Teams: A Contemporary Review. Curr Cardiol Rep 25, 1657–1663 (2023). https://doi.org/10.1007/s11886-023-01983-7

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