Cardiac ICUs with shock teams deliver superior patient care
Cardiac ICUs with dedicated shock teams provide better patient care for cardiogenic shock (CS) patients, according to new findings published in the Journal of the American College of Cardiology.
“Given the time-sensitive nature of the complex medical, catheter-based, and surgical treatments used in caring for patients with CS, some centers have developed and implemented multidisciplinary ‘shock teams’ that include representation from critical care cardiology, advanced heart failure and transplant cardiology, interventional cardiology, extracorporeal membrane oxygenation and cardiac surgery specialties,” explained first author Alexander I. Papolos, MD, of MedStar Washington Hospital Center, and colleagues. “The purpose of such a shock team is to facilitate early shock recognition and expedite multidisciplinary discussions regarding evaluation and management, including the need for timely mechanical circulatory support (MCS) and appropriate device selection when indicated.”
Papolos et al. examined outcomes from 24 different cardiac ICUs in North America. Ten of those facilities had shock teams. The group focused on care provided during annual two-month “snapshot” periods in 2017, 2018 and 2019.
Among the 1,242 CS admissions included in the study, 44% were at facilities where care was provided by a dedicated shock team.
Facilities with shock teams used more pulmonary artery catheters (60% vs. 49%). They were also more likely to use advanced types of MCS instead of intra-aortic balloon pumps (53% vs. 43%), but they used MCS less overall (35% vs. 43%).
In addition, these facilities were associated with a shorter median ICU length of stay (4.0 days vs. 5.1 days) and a lower risk-adjusted mortality rate (23% vs. 29%).
Papolos and colleagues did emphasize that each shock team was developed to meet that specific facility’s needs, so there was “no standardization from one team to another.” Even with that caveat in mind, however, the authors wrote that health systems should at least consider assembling such a team to improve patient care.
“Centers with shock teams appear to have higher CS-related CICU survival and reduced CICU resource use,” they wrote. “Our data support considering the implementation of shock teams at tertiary cardiovascular centers.”
The full Journal of the American College of Cardiology analysis is available here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.