Shock Team Approach in Refractory Cardiogenic Shock Requiring Short-Term Mechanical Circulatory Support

HomeCirculationVol. 140, No. 1Shock Team Approach in Refractory Cardiogenic Shock Requiring Short-Term Mechanical Circulatory Support Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBShock Team Approach in Refractory Cardiogenic Shock Requiring Short-Term Mechanical Circulatory SupportA Proof of Concept Iosif Taleb, MD, Antigone G. Koliopoulou, MD, Anwar Tandar, MD, Stephen H. McKellar, MD, MSc, Joseph E. Tonna, MD, Jose Nativi-Nicolau, MD, Miguel Alvarez Villela, MD, Frederick Welt, MD, Josef Stehlik, MD, MPH, Edward M. Gilbert, MD, Omar Wever-Pinzon, MD, Jack H. Morshedzadeh, MD, Elizabeth Dranow, PhD, Craig H. Selzman, MD, James C. Fang, MD and Stavros G. Drakos, MD, PhD Iosif TalebIosif Taleb Division of Cardiovascular Medicine (I.T., A.T., J.N-N., M.A.V., F.W., J.S., E.M.G., O.W-P., J.H.M., E.D., J.C.F., S.G.D.), University of Utah School of Medicine, Salt Lake City. Search for more papers by this author , Antigone G. KoliopoulouAntigone G. Koliopoulou Division of Cardiothoracic Surgery (A.G.K., S.H.M., J.E.T., C.H.S.), University of Utah School of Medicine, Salt Lake City. Cardiovascular Intensive Care Unit, University of Utah Health, Salt Lake City (A.G.K., A.T., S.H.M., J.E.T., J.N-N., F.W., J.S., E.M.G., O.W-P., J.H.M., C.H.S., J.C.F., S.G.D.). Search for more papers by this author , Anwar TandarAnwar Tandar Division of Cardiovascular Medicine (I.T., A.T., J.N-N., M.A.V., F.W., J.S., E.M.G., O.W-P., J.H.M., E.D., J.C.F., S.G.D.), University of Utah School of Medicine, Salt Lake City. Cardiovascular Intensive Care Unit, University of Utah Health, Salt Lake City (A.G.K., A.T., S.H.M., J.E.T., J.N-N., F.W., J.S., E.M.G., O.W-P., J.H.M., C.H.S., J.C.F., S.G.D.). Search for more papers by this author , Stephen H. McKellarStephen H. McKellar Division of Cardiothoracic Surgery (A.G.K., S.H.M., J.E.T., C.H.S.), University of Utah School of Medicine, Salt Lake City. Cardiovascular Intensive Care Unit, University of Utah Health, Salt Lake City (A.G.K., A.T., S.H.M., J.E.T., J.N-N., F.W., J.S., E.M.G., O.W-P., J.H.M., C.H.S., J.C.F., S.G.D.). Search for more papers by this author , Joseph E. TonnaJoseph E. Tonna Division of Cardiothoracic Surgery (A.G.K., S.H.M., J.E.T., C.H.S.), University of Utah School of Medicine, Salt Lake City. Cardiovascular Intensive Care Unit, University of Utah Health, Salt Lake City (A.G.K., A.T., S.H.M., J.E.T., J.N-N., F.W., J.S., E.M.G., O.W-P., J.H.M., C.H.S., J.C.F., S.G.D.). Search for more papers by this author , Jose Nativi-NicolauJose Nativi-Nicolau Division of Cardiovascular Medicine (I.T., A.T., J.N-N., M.A.V., F.W., J.S., E.M.G., O.W-P., J.H.M., E.D., J.C.F., S.G.D.), University of Utah School of Medicine, Salt Lake City. Cardiovascular Intensive Care Unit, University of Utah Health, Salt Lake City (A.G.K., A.T., S.H.M., J.E.T., J.N-N., F.W., J.S., E.M.G., O.W-P., J.H.M., C.H.S., J.C.F., S.G.D.). Search for more papers by this author , Miguel Alvarez VillelaMiguel Alvarez Villela Division of Cardiovascular Medicine (I.T., A.T., J.N-N., M.A.V., F.W., J.S., E.M.G., O.W-P., J.H.M., E.D., J.C.F., S.G.D.), University of Utah School of Medicine, Salt Lake City. Search for more papers by this author , Frederick WeltFrederick Welt Division of Cardiovascular Medicine (I.T., A.T., J.N-N., M.A.V., F.W., J.S., E.M.G., O.W-P., J.H.M., E.D., J.C.F., S.G.D.), University of Utah School of Medicine, Salt Lake City. Cardiovascular Intensive Care Unit, University of Utah Health, Salt Lake City (A.G.K., A.T., S.H.M., J.E.T., J.N-N., F.W., J.S., E.M.G., O.W-P., J.H.M., C.H.S., J.C.F., S.G.D.). Search for more papers by this author , Josef StehlikJosef Stehlik Division of Cardiovascular Medicine (I.T., A.T., J.N-N., M.A.V., F.W., J.S., E.M.G., O.W-P., J.H.M., E.D., J.C.F., S.G.D.), University of Utah School of Medicine, Salt Lake City. Cardiovascular Intensive Care Unit, University of Utah Health, Salt Lake City (A.G.K., A.T., S.H.M., J.E.T., J.N-N., F.W., J.S., E.M.G., O.W-P., J.H.M., C.H.S., J.C.F., S.G.D.). Search for more papers by this author , Edward M. GilbertEdward M. Gilbert Division of Cardiovascular Medicine (I.T., A.T., J.N-N., M.A.V., F.W., J.S., E.M.G., O.W-P., J.H.M., E.D., J.C.F., S.G.D.), University of Utah School of Medicine, Salt Lake City. Cardiovascular Intensive Care Unit, University of Utah Health, Salt Lake City (A.G.K., A.T., S.H.M., J.E.T., J.N-N., F.W., J.S., E.M.G., O.W-P., J.H.M., C.H.S., J.C.F., S.G.D.). Search for more papers by this author , Omar Wever-PinzonOmar Wever-Pinzon Division of Cardiovascular Medicine (I.T., A.T., J.N-N., M.A.V., F.W., J.S., E.M.G., O.W-P., J.H.M., E.D., J.C.F., S.G.D.), University of Utah School of Medicine, Salt Lake City. Cardiovascular Intensive Care Unit, University of Utah Health, Salt Lake City (A.G.K., A.T., S.H.M., J.E.T., J.N-N., F.W., J.S., E.M.G., O.W-P., J.H.M., C.H.S., J.C.F., S.G.D.). Search for more papers by this author , Jack H. MorshedzadehJack H. Morshedzadeh Division of Cardiovascular Medicine (I.T., A.T., J.N-N., M.A.V., F.W., J.S., E.M.G., O.W-P., J.H.M., E.D., J.C.F., S.G.D.), University of Utah School of Medicine, Salt Lake City. Cardiovascular Intensive Care Unit, University of Utah Health, Salt Lake City (A.G.K., A.T., S.H.M., J.E.T., J.N-N., F.W., J.S., E.M.G., O.W-P., J.H.M., C.H.S., J.C.F., S.G.D.). Search for more papers by this author , Elizabeth DranowElizabeth Dranow Division of Cardiovascular Medicine (I.T., A.T., J.N-N., M.A.V., F.W., J.S., E.M.G., O.W-P., J.H.M., E.D., J.C.F., S.G.D.), University of Utah School of Medicine, Salt Lake City. Search for more papers by this author , Craig H. SelzmanCraig H. Selzman Division of Cardiothoracic Surgery (A.G.K., S.H.M., J.E.T., C.H.S.), University of Utah School of Medicine, Salt Lake City. Cardiovascular Intensive Care Unit, University of Utah Health, Salt Lake City (A.G.K., A.T., S.H.M., J.E.T., J.N-N., F.W., J.S., E.M.G., O.W-P., J.H.M., C.H.S., J.C.F., S.G.D.). Search for more papers by this author , James C. FangJames C. Fang Division of Cardiovascular Medicine (I.T., A.T., J.N-N., M.A.V., F.W., J.S., E.M.G., O.W-P., J.H.M., E.D., J.C.F., S.G.D.), University of Utah School of Medicine, Salt Lake City. Cardiovascular Intensive Care Unit, University of Utah Health, Salt Lake City (A.G.K., A.T., S.H.M., J.E.T., J.N-N., F.W., J.S., E.M.G., O.W-P., J.H.M., C.H.S., J.C.F., S.G.D.). Search for more papers by this author and Stavros G. DrakosStavros G. Drakos Stavros G. Drakos, MD, PhD, Division of Cardiovascular Medicine & Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah School of Medicine, 30 North 1900 East, Room 4A150, Salt Lake City, UT 84132. Email E-mail Address: [email protected] Division of Cardiovascular Medicine (I.T., A.T., J.N-N., M.A.V., F.W., J.S., E.M.G., O.W-P., J.H.M., E.D., J.C.F., S.G.D.), University of Utah School of Medicine, Salt Lake City. Cardiovascular Intensive Care Unit, University of Utah Health, Salt Lake City (A.G.K., A.T., S.H.M., J.E.T., J.N-N., F.W., J.S., E.M.G., O.W-P., J.H.M., C.H.S., J.C.F., S.G.D.). Search for more papers by this author Originally published1 Jul 2019https://doi.org/10.1161/CIRCULATIONAHA.119.040654Circulation. 2019;140:98–100Despite efforts to improve treatment of refractory cardiogenic shock (rCS), prognosis remains poor. Multidisciplinary Shock Teams have been proposed as a strategy to streamline care delivery and improve outcomes despite the lack of strong evidence.1–5 This study sought to determine the feasibility and efficacy of the Shock Team approach for rCS at our tertiary care institution.The Utah Cardiac Recovery Shock Team was established in April 2015 to evaluate patients in acute cardiogenic shock (CS) with a standardized comprehensive multidisciplinary assessment. From April 2015 to August 2018, we prospectively identified 123 consecutive patients with rCS, treated with mechanical circulatory support (MCS), using the Team approach. We compared this cohort with the immediately preceding 121 rCS patients, treated with MCS, but without Shock Team evaluation (control cohort) in a retrospective fashion. Postcardiotomy patients and those requiring central extracorporeal membrane oxygenation were excluded. The study was approved by the University of Utah’s Institutional Review Board, and participants gave written informed consent.The Shock Team comprises a heart failure cardiologist, a heart failure cardiothoracic surgeon, an interventional cardiologist, and a Cardiovascular Intensive Care Unit attending physician. Once activated, all Team members participate in the decisions surrounding patient management and therapeutic options. Activations after hours or on weekends do not automatically bring all the on-call staff in; however, it initiates a discussion between the involved parties. The heart failure cardiologist performs the initial screening when clinical suspicion of CS exists and serves as the central hub coordinating the whole process. Once a patient is deemed to have CS, empirical medical therapy is initiated and arterial line placement, right heart catheterization, and coronary revascularization ensue as warranted, based on the clinical scenario. If, despite optimal medical therapy, the patient remains hypotensive, and cardiac index is <2.2 L/(min · m2) and pulmonary capillary wedge pressure or left ventricular end-diastolic pressure is >15 mm Hg, or the patient has clinical signs of impaired end-organ perfusion, then escalation to short-term MCS is considered, and device selection is made by consensus of all Team members. The patient continues to be managed by the Team until resolution of CS, or until a decision is made to deescalate care respecting the patient’s or family’s wishes.The primary end point was 30-day all-cause mortality. Secondary end points included shock-to-support time (as a surrogate of the feasibility of the Team approach), in-hospital survival, length of MCS support, escalation to surgically implantable durable ventricular assist device, and length of intensive care unit stay.The baseline patient characteristics are presented in the Figure (A). After institution of the Shock Team, the primary outcome of 30-day all-cause mortality decreased in the univariate analysis and this effect persisted after controlling for relevant confounders (hazard ratio: 0.61 [95% CI, 0.41–0.93]; Figure [B]). The multivariate modeling also identified acute coronary syndrome–related CS (HR: 2.76 [95% CI, 1.69–4.50]), lactate level (HR: 1.14 [95% CI, 1.10–1.18]), and acute kidney injury (HR: 2.12 [95% CI, 1.36–3.32]) as independent risk factors at the time of MCS institution, associated with 30-day mortality. Of note, device type was not associated with a survival benefit. Sensitivity analysis suggests no interaction on the effect of the Shock Team on 30-day mortality when examining the CS cause (ST-segment–elevation myocardial infarction, non–ST-segment–elevation myocardial infarction, acute decompensated heart failure, and other), the location of the onset of CS (ie, referring versus University of Utah hospital), and the presence of cardiopulmonary resusitation. A time series analysis to address a time trend was not possible due to few time points of data to reliably fit a model. In-hospital survival also favored the Shock Team (61.0% versus 47.9%; P=0.041). The secondary outcome of Shock-to-Support time was comparable between the Shock Team and control (19±5 versus 25±8 hours; P=0.52). Likewise, the mean length of MCS support was similar between the groups (121±13 versus 104±16 hours). Among the 133 (54.5%) survivors to hospital discharge, 99 experienced improvement leading to MCS weaning, whereas 34 were bridged to a surgically implantable durable left ventricular assist device. The overall mean intensive care unit stay was similar between the groups. No significant differences were seen between the groups in the rates of major bleeding, cerebrovascular accidents, rates of hemolysis and major vascular complication leading to surgical vascular repair, fasciotomy, or amputation.Download figureDownload PowerPointFigure. Shock Team approach appears to be feasible and beneficial in the management of refractory cardiogenic shock.A, Baseline characteristics of study population. Data expressed as mean±SE or n (%). B, Shock Team algorithm and adjusted Kaplan-Meier 30-day survival. ACS indicates acute coronary syndrome; BP, blood pressure; CCO, continuous cardiac output; CI, cardiac index; COPD, chronic obstructive pulmonary disease; CPR, cardiopulmonary resuscitation; CT, cardiothoracic; CVICU, cardiovascular intensive care unit; HF, heart failure; HFrEF, heart failure reduced ejection fraction; IABP, intra-aortic balloon pump; LHC, left heart catheterization; LVEDP, left ventricular end-diastolic pressure; LVEF, left ventricular ejection fraction; MCS, mechanical circulatory support; PCI, percutaneous coronary intervention; PCWP, pulmonary capillary wedge pressure; RAP, right atrial pressure; RHC, right heart catheterization; STEMI, ST-segment–elevation myocardial infarction; s-t MCS, short-term mechanical circulatory support; SVR, systemic vascular resistance; UoU, University of Utah hospital; and VA-ECMO, veno-arterial extracorporeal membrane oxygenation. *Criteria for considering s-t MCS: low systemic blood pressure (SBP) <90 mm Hg OR mean arterial pressure <50 mm Hg for >30 mins OR needed IV vasoactive agents infusion to maintain SBP>90 mm Hg or MAP>50 mm Hg, plus 1 of the following: PCWP or LVEDP>15 mm Hg and CI<2.2 L/(min · m2) OR signs of pulmonary edema, OR impaired end-organ perfusion, defined as altered mental status; or cold, clammy skin and extremities; or urine output <30 mL/h.In this study, the multidisciplinary Shock Team approach for the treatment of rCS decreased in-hospital and 30-day all-cause mortality. This strategy may constitute an opportunity to improve the management of this condition, for which multiple interventions and devices have failed to show a survival benefit. Importantly, our finding on the secondary outcome of Shock-to-Support time addresses the concern of delaying care with increasing the number of providers comprising the Shock Team. Indeed, a multidisciplinary approach did not delay the implementation of critical decisions, while ensuring appropriate level of support and planning in case escalation was needed. After 4 years of implementation in our institution, the Shock Team initiative remains fully operational, suggesting the sustainability of such programs in clinical practice. These encouraging findings warrant validation by prospective large-scale randomized controlled trials.AcknowledgmentsWe are thankful to Greg Stoddard MPH, MBA, for statistical support. Also, we are thankful to ABIOMED for providing the required funding for the first year of our prospective Cardiogenic Shock Registry.Sources of FundingFinancial support to Dr Drakos was provided by the American Heart Association Heart Failure Strategically Focused Research Network, 16SFRN29020000, NHLBI R01 HL135121-01, NHLBI R01 HL132067-01A1, and the Nora Eccles Treadwell Foundation, Salt Lake City, UT. ABIOMED funded the first year of our prospective registry.DisclosuresDr Drakos is a consultant to Abbott. The other authors report no conflicts.FootnotesData sharing: The data that support the findings of this study are available from the corresponding author upon reasonable request.Stavros G. Drakos, MD, PhD, Division of Cardiovascular Medicine & Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah School of Medicine, 30 North 1900 East, Room 4A150, Salt Lake City, UT 84132. Email stavros.[email protected]utah.eduReferences1. Tchantchaleishvili V, Hallinan W, Massey HT. Call for organized statewide networks for management of acute myocardial infarction-related cardiogenic shock.JAMA Surg. 2015; 150:1025–1026. doi: 10.1001/jamasurg.2015.2412CrossrefMedlineGoogle Scholar2. van Diepen S, Katz JN, Albert NM, Henry TD, Jacobs AK, Kapur NK, Kilic A, Menon V, Ohman EM, Sweitzer NK, Thiele H, Washam JB, Cohen MG; American Heart Association Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Quality of Care and Outcomes Research; and Mission: Lifeline. Contemporary management of cardiogenic shock: a scientific statement from the American Heart Association.Circulation. 2017; 136:e232–e268. doi: 10.1161/CIR.0000000000000525LinkGoogle Scholar3. Rab T, Ratanapo S, Kern KB, Basir MB, McDaniel M, Meraj P, King SB, O’Neill W. Cardiac shock care centers: JACC review topic of the week.J Am Coll Cardiol. 2018; 72:1972–1980. doi: 10.1016/j.jacc.2018.07.074CrossrefMedlineGoogle Scholar4. Takayama H, Truby L, Koekort M, Uriel N, Colombo P, Mancini DM, Jorde UP, Naka Y. Clinical outcome of mechanical circulatory support for refractory cardiogenic shock in the current era.J Heart Lung Transplant. 2013; 32:106–111. doi: 10.1016/j.healun.2012.10.005CrossrefMedlineGoogle Scholar5. Tehrani BN, Truesdell AG, Sherwood MW, Desai S, Tran HA, Epps KC, Singh R, Psotka M, Shah P, Cooper LB, Rosner C, Raja A, Barnett SD, Saulino P, deFilippi CR, Gurbel PA, Murphy CE, O’Connor CM. Standardized team-based care for cardiogenic shock.J Am Coll Cardiol. 2019; 73:1659–1669. doi: 10.1016/j.jacc.2018.12.084CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Owyang C, Donnat C, Brodie D, Gershengorn H, Hua M, Qadir N and Tonna J (2022) Similarities in extracorporeal membrane oxygenation management across intensive care unit types in the United States: An analysis of the Extracorporeal Life Support Organization Registry, Artificial Organs, 10.1111/aor.14193, 46:7, (1369-1381), Online publication date: 1-Jul-2022. Sinha S, Rosner C, Tehrani B, Maini A, Truesdell A, Lee S, Bagchi P, Cameron J, Damluji A, Desai M, Desai S, Epps K, deFilippi C, Flanagan M, Genovese L, Moukhachen H, Park J, Psotka M, Raja A, Shah P, Sherwood M, Singh R, Tang D, Young K, Welch T, O’Connor C and Batchelor W (2022) Cardiogenic Shock From Heart Failure Versus Acute Myocardial Infarction: Clinical Characteristics, Hospital Course, and 1-Year Outcomes, Circulation: Heart Failure, 15:6, (e009279), Online publication date: 1-Jun-2022. Fried J, Griffin J, Masoumi A, Clerkin K, Witer L, Topkara V, Karmpaliotis D, Rabbani L, Colombo P, Yuzefpolskaya M, Takayama H, Naka Y, Kirtane A, Brodie D, Sayer G, Uriel N, Takeda K and Garan A (2022) Predictors of Survival and Ventricular Recovery Following Acute Myocardial Infarction Requiring Extracorporeal Membrane Oxygenation Therapy, ASAIO Journal, 10.1097/MAT.0000000000001570, 68:6, (800-807), Online publication date: 1-Jun-2022. Bloom J, Andrew E, Nehme Z, Beale A, Dawson L, Shi W, Vriesendorp P, Fernando H, Noaman S, Cox S, Stephenson M, Anderson D, Chan W, Kaye D, Smith K and Stub D (2022) Gender Disparities in Cardiogenic Shock Treatment and Outcomes, The American Journal of Cardiology, 10.1016/j.amjcard.2022.04.047, Online publication date: 1-Jun-2022. Krause T and Rieth A (2022) Aktuelle Klassifikation und hämodynamisches Profil bei kardiogenem SchockUpdated classification and hemodynamics in cardiogenic shock, Zeitschrift für Herz-,Thorax- und Gefäßchirurgie, 10.1007/s00398-022-00507-9, 36:3, (158-163), Online publication date: 1-Jun-2022. Masiero G, Cardaioli F and Tarantini G (2022) Mechanical circulatory support in cardiogenic shock: a critical appraisal, Expert Review of Cardiovascular Therapy, 10.1080/14779072.2022.2078702, (1-12) Heidenreich P, Bozkurt B, Aguilar D, Allen L, Byun J, Colvin M, Deswal A, Drazner M, Dunlay S, Evers L, Fang J, Fedson S, Fonarow G, Hayek S, Hernandez A, Khazanie P, Kittleson M, Lee C, Link M, Milano C, Nnacheta L, Sandhu A, Stevenson L, Vardeny O, Vest A and Yancy C (2022) 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines, Circulation, 145:18, (e895-e1032), Online publication date: 3-May-2022. Brusca S, Caughron H, Njoroge J, Cheng R, O’Brien C and Barnett C (2022) The shock team: a multidisciplinary approach to early patient phenotyping and appropriate care escalation in cardiogenic shock, Current Opinion in Cardiology, 10.1097/HCO.0000000000000967, 37:3, (241-249), Online publication date: 1-May-2022. Heidenreich P, Bozkurt B, Aguilar D, Allen L, Byun J, Colvin M, Deswal A, Drazner M, Dunlay S, Evers L, Fang J, Fedson S, Fonarow G, Hayek S, Hernandez A, Khazanie P, Kittleson M, Lee C, Link M, Milano C, Nnacheta L, Sandhu A, Stevenson L, Vardeny O, Vest A and Yancy C (2022) 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure, Journal of the American College of Cardiology, 10.1016/j.jacc.2021.12.012, 79:17, (e263-e421), Online publication date: 1-May-2022. Shah T, Kapadia S, Lansky A and Grines C (2022) ST-Segment Elevation Myocardial Infarction: Sex Differences in Incidence, Etiology, Treatment, and Outcomes, Current Cardiology Reports, 10.1007/s11886-022-01676-7, 24:5, (529-540), Online publication date: 1-May-2022. Vallabhajosyula S, Katz J and Menon V (2022) Quantification of Vasoactive Medications and the “Pharmaco-Mechanical Continuum” in Cardiogenic Shock, Circulation: Heart Failure, 15:4, (e008736), Online publication date: 1-Apr-2022. Tehrani B, Damluji A and Batchelor W Acute Myocardial Infarction and Cardiogenic Shock Interventional Approach to Management in the Cardiac Catheterization Laboratories, Current Cardiology Reviews, 10.2174/1573403X17666211125090929, 18:2 Scolari F, Trott G, Schneider D, Goldraich L, Frederico Tonietto T, Moura L, Bertoldi E, Rover M, Wolf J, Souza D, Clausell N, Polanczyk C, Rohde L, Rosa R and Wainstein R (2022) Cardiogenic shock treated with temporary mechanical circulatory support in Brazil: The effect of learning curve, The International Journal of Artificial Organs, 10.1177/03913988211070841, 45:3, (292-300), Online publication date: 1-Mar-2022. Tehrani B, Drakos S, Billia F, Batchelor W, Luk A, Stelling K, Tonna J, Rosner C, Hanff T, Rao V, Brozzi N and Baran D (2022) The Multicenter Collaborative to Enhance Biologic Understanding, Quality, and Outcomes in Cardiogenic Shock (VANQUISH Shock): Rationale and Design, Canadian Journal of Cardiology, 10.1016/j.cjca.2022.03.005, Online publication date: 1-Mar-2022. Hernandez-Montfort J, Miranda D, Randhawa V, Sleiman J, de Armas Y, Lewis A, Taimeh Z, Alvarez P, Cremer P, Perez-Villa B, Navas V, Hakemi E, Velez M, Hernandez-Mejia L, Sheffield C, Brozzi N, Cubeddu R, Navia J and Estep J (2022) Hemodynamic-based Assessment and Management of Cardiogenic Shock, US Cardiology Review, 10.15420/usc.2021.12, 16 Shankar A, Gurumurthy G, Sridharan L, Gupta D, Nicholson W, Jaber W and Vallabhajosyula S (2022) A Clinical Update on Vasoactive Medication in the Management of Cardiogenic Shock, Clinical Medicine Insights: Cardiology, 10.1177/11795468221075064, 16, (117954682210750), Online publication date: 1-Jan-2022. Quien M, Thomas A, Ludmir J and Miller P (2022) Staffing models in the cardiac intensive care unit, Current Opinion in Critical Care, 10.1097/MCC.0000000000000958, Publish Ahead of Print Hsu S, Fang J and Borlaug B (2022) Hemodynamics for the Heart Failure Clinician: A State-of-the-Art Review, Journal of Cardiac Failure, 10.1016/j.cardfail.2021.07.012, 28:1, (133-148), Online publication date: 1-Jan-2022. Ponamgi S, Maqsood M, Sundaragiri P, DelCore M, Kanmanthareddy A, Jaber W, Nicholson W and Vallabhajosyula S (2021) Pulmonary artery catheterization in acute myocardial infarction complicated by cardiogenic shock: A review of contemporary literature, World Journal of Cardiology, 10.4330/wjc.v13.i12.720, 13:12, (720-732), Online publication date: 26-Dec-2022. Proudfoot A, Kalakoutas A, Meade S, Griffiths M, Basir M, Burzotta F, Chih S, Fan E, Haft J, Ibrahim N, Kruit N, Lim H, Morrow D, Nakata J, Price S, Rosner C, Roswell R, Samaan M, Samsky M, Thiele H, Truesdell A, van Diepen S, Voeltz M and Irving P (2021) Contemporary Management of Cardiogenic Shock: A RAND Appropriateness Panel Approach, Circulation: Heart Failure, 14:12, Online publication date: 1-Dec-2021. Basir M, Pinto D, Ziaeian B, Khandelwal A, Cowger J, Suh W and Althouse A (2021) Mechanical circulatory support in acute myocardial infarction and cardiogenic shock: Challenges and importance of randomized control trials, Catheterization and Cardiovascular Interventions, 10.1002/ccd.29593, 98:7, (1264-1274), Online publication date: 1-Dec-2021. Marashly Q, Taleb I, Kyriakopoulos C, Dranow E, Jones T, Tandar A, Overton S, Tonna J, Stoddard K, Wever‐Pinzon O, Kemeyou L, Koliopoulou A, Shah K, Nourian K, Richins T, Burnham T, Welt F, McKellar S, Nativi‐Nicolau J and Drakos S (2021) Predicting mortality in cardiogenic shock secondary to ACS requiring short‐term mechanical circulatory support: The ACS‐MCS score , Catheterization and Cardiovascular Interventions, 10.1002/ccd.29581, 98:7, (1275-1284), Online publication date: 1-Dec-2021. Samsky M, Morrow D, Proudfoot A, Hochman J, Thiele H and Rao S (2021) Cardiogenic Shock After Acute Myocardial Infarction, JAMA, 10.1001/jama.2021.18323, 326:18, (1840), Online publication date: 9-Nov-2021. Warren A, Rosner C, Gattani R, Truesdell A and Proudfoot A (2021) Cardiogenic Shock: Protocols, Teams, Centers, and Networks, US Cardiology Review, 10.15420/usc.2021.10, 15 Schrage B, Zeymer U, Montalescot G, Windecker S, Serpytis P, Vrints C, Stepinska J, Savonitto S, Oldroyd K, Desch S, Fuernau G, Huber K, Noc M, Schneider S, Ouarrak T, Blankenberg S, Thiele H and Clemmensen P (2021) Impact of Center Volume on Outcomes in Myocardial Infarction Complicated by Cardiogenic Shock: A CULPRIT‐SHOCK Substudy, Journal of the American Heart Association, 10:20, Online publication date: 19-Oct-2021.Osman M, Syed M, Patel B, Munir M, Kheiri B, Caccamo M, Sokos G, Balla S, Basir M, Kapur N, Mamas M and Bianco C (2021) Invasive Hemodynamic Monitoring in Cardiogenic Shock Is Associated With Lower In‐Hospital Mortality, Journal of the American Heart Association, 10:18, Online publication date: 21-Sep-2021. Alvarez Villela M, Clark R, William P, Sims D and Jorde U (2021) Systems of Care in Cardiogenic Shock, Frontiers in Cardiovascular Medicine, 10.3389/fcvm.2021.712594, 8 Papolos A, Kenigsberg B, Berg D, Alviar C, Bohula E, Burke J, Carnicelli A, Chaudhry S, Drakos S, Gerber D, Guo J, Horowitz J, Katz J, Keeley E, Metkus T, Nativi-Nicolau J, Snell J, Sinha S, Tymchak W, Van Diepen S, Morrow D and Barnett C (2021) Management and Outcomes of Cardiogenic Shock in Cardiac ICUs With Versus Without Shock Teams, Journal of the American College of Cardiology, 10.1016/j.jacc.2021.07.044, 78:13, (1309-1317), Online publication date: 1-Sep-2021. Osman M, Syed M, Patibandla S, Sulaiman S, Kheiri B, Shah M, Bianco C, Balla S and Patel B (2021) Fifteen‐Year Trends in Incidence of Cardiogenic Shock Hospitalization and In‐Hospital Mortality in the United States, Journal of the American Heart Association, 10:15, Online publication date: 3-Aug-2021. Berg D, Bohula E and Morrow D (2021) Epidemiology and causes of cardiogenic shock, Current Opinion in Critical Care, 10.1097/MCC.0000000000000845, 27:4, (401-408), Online publication date: 1-Aug-2021. Sperry A, Williams M, Atluri P, Szeto W, Cevasco M, Bermudez C, Acker M and Ibrahim M (2021) The Surgeon’s Role in Cardiogenic Shock, Current Heart Failure Reports, 10.1007/s11897-021-00514-1, 18:4, (240-251), Online publication date: 1-Aug-2021. Kunkel K, Fuller B and Basir M (2021) Management of Cardiogenic Shock in Patients with Acute Myocardial Infarction, Interventional Cardiology Clinics, 10.1016/j.iccl.2021.03.006, 10:3, (345-357), Online publication date: 1-Jul-2021. Sturm R, Jones T, Youngquist S and Shah R (2021) Regional Systems of Care in ST Elevation Myocardial Infarction, Interventional Cardiology Clinics, 10.1016/j.iccl.2021.03.001, 10:3, (281-291), Online publication date: 1-Jul-2021. Singh S, Witer L, Kaku Y, Masoumi A, Fried J, Yuzefpolskaya M, Colombo P, Sayer G, Uriel N, Naka Y, Takayama H and Takeda K (2021) Temporary surgical ventricular assist device for treatment of acute myocardial infarction and refractory cardiogenic shock in the percutaneous device era, Journal of Artificial Organs, 10.1007/s10047-020-01236-2, 24:2, (199-206), Online publication date: 1-Jun-2021. Henry T, Tomey M, Tamis-Holland J, Thiele H, Rao S, Menon V, Klein D, Naka Y, Piña I, Kapur N and Dangas G (2021) Invasive Management of Acute Myocardial Infarction Complicated by Cardiogenic Shock: A Scientific Statement From the American Heart Association, Circulation, 143:15, (e815-e829), Online publication date: 13-Apr-2021. Lemor A, Ya’qoub L and Basir M (2021) Mechanical Circulatory Support in Acute Myocardial Infarction and Cardiogenic Shock, Interventional Cardiology Clinics, 10.1016/j.iccl.2020.12.005, 10:2, (169-184), Online publication date: 1-Apr-2021. Schrage B, Becher P, Goßling A, Savarese G, Dabboura S, Yan I, Beer B, Söffker G, Seiffert M, Kluge S, Kirchhof P, Blankenberg S and Westermann D (2021) Temporal trends in incidence, causes, use of mechanical circulatory support and mortality in cardiogenic shock, ESC Heart Failure, 10.1002/ehf2.13202, 8:2, (1295-1303), Online publication date: 1-Apr-2021. Moghaddam N, Diepen S, So D, Lawler P and Fordyce C (2021) Cardiogenic shock teams and centres: a contemporary review of multidisciplinary care for cardiogenic shock, ESC Heart Failure, 10.1002/ehf2.13180, 8:2, (988-998), Online publication date: 1-Apr-2021. Omer M, Exaire J, Jentzer J, Sandoval Y, Singh M, Cagin C, Elgendy I and Tak T (2021) Management of ST-Elevation Myocardial Infarction in High-Risk Settings, International Journal of Angiology, 10.1055/s-0041-1723941, 30:01, (053-066), Online publication date: 1-Mar-2021. Ya’qoub L, Lemor A, Dabbagh M, O’Neill W, Khandelwal A, Martinez S, Ibrahim N, Grines C, Voeltz M and Basir M (2021) Racial, Ethnic, and Sex Disparities in Patients With STEMI and Cardiogenic Shock, JACC: Cardiovascular Interventions, 10.1016/j.jcin.2021.01.003, 14:6, (653-660), Online publication date: 1-Mar-2021. Gong F, Vaitenas I, Malaisrie S and Maganti K (2021) Mechanical Complications of Acute Myocardial Infarction, JAMA Cardiology, 10.1001/jamacardio.2020.3690, 6:3, (341), Online publication date: 1-Mar-2021. Díaz Molina B, González Costello J and Barge-Caballero E (2021) Código shock en España. El próximo salto de calidad en la asistencia cardiológica ya está aquí, Revista Española de Cardiología, 10.1016/j.recesp.2020.07.026, 74:1, (5-7), Online publication date: 1-Jan-2021. Hernández-Pérez F, Álvarez-Avelló J, Forteza A, Gómez-Bueno M, González A, López-Ibor J, Silva-Melchor L, Goicolea J, Martín C, Iranzo R, Goirigolzarri-Artaza J, Escudier-Villa J, Ortega-Marcos J, Oteo-Domínguez J, Herrero-Cano Á, Moñivas V, Mingo-Santos S, Villar S, Jiménez-Blanco M, Coscia C, Serrano-Fiz S, Alonso-Pulpón L and Segovia-Cubero J (2021) Resultados iniciales de un programa multidisciplinario de atención a pacientes en shock cardiogénico en red, Revista Española de Cardiología, 10.1016/j.recesp.2020.01.019, 74:1, (33-43), Online publication date: 1-Jan-2021. Díaz Molina B, González Costello J and Barge-Caballero E (2021) The shock code in Spain. The next quality leap in cardiological care is here, Revista Española de Cardiología (English Edition), 10.1016/j.rec.2020.07.017, 74:1, (5-7), Online publication date: 1-Jan-2021. Hernández-Pérez F, Álvarez-Avelló J, Forteza A, Gómez-Bueno M, González A, López-Ibor J, Silva-Melchor L, Goicolea J, Martín C, Iranzo R, Goirigolzarri-Artaza J, Escudier-Villa J, Ortega-Marcos J, Oteo-Domínguez J, Herrero-Cano Á, Moñivas V, Mingo-Santos S, Villar S, Jiménez-Blanco M, Coscia C, Serrano-Fiz S, Alonso-Pulpón L and Segovia-Cubero J (2021) Initial outcomes of a multidisciplinary network for the care of patients with cardiogenic shock, Revista Española de Cardiología (English Edition), 10.1016/j.rec.2020.03.010, 74:1, (33-43), Online publication date: 1-Jan-2021. García-Pinilla J, García-Cosío Carmena M, Farrero-Torres M, Recio-Mayoral A and González-Costello J (2021) Selección de lo mejor del año 2020 en insuficiencia cardiaca, REC: CardioClinics, 10.1016/j.rccl.2020.11.009, 56, (66-71), Online publication date: 1-Jan-2021. Viana-Tejedor A, Uribarri A, Martínez Losas P, Andrea R, Corbí Pascual M, Jorge Pérez P, Ariza Solé A and López de Sá E (2021) Selección de lo mejor del año 2020 en cardiopatía isquémica y cuidados críticos cardiológicos, REC: CardioClinics, 10.1016/j.rccl.2020.10.011, 56, (35-40), Online publication date: 1-Jan-2021. Gibbs D, Eusebio C, Sanders J, Rosner C, Tehrani B, Truesdell A, O'Brien B, Finney S and Proudfoot A (2021) Clinician Perceptions of the Impact of a Shock Team Approach in the Management of Cardiogenic Shock: A Qualitative Study, Cardiovascular Revascularization Medicine, 10.1016/j.carrev.2020.06.011, 22, (78-83), Online publication date: 1-Jan-2021. Brilakis E (2021) Complex patient subgroups Manual of Percutaneous Coronary Interventions, 10.1016/B978-0-12-819367-9.00024-X, (397-406), . Wang J, Lu D, MHS , Feldman D, McCullough S, Goyal P, Karas M, Sobol I, Horn E, Kim L and Krishnan U (2020) Outcomes of Hospitalizations for Cardiogenic Shock at Left Ventricular Assist Device Versus Non–Left Ventricular Assist Device Centers, Journal of the American Heart Association, 9:23, Online publication date: 1-Dec-2020. Baran D, Long A, Badiye A and Stelling K (2020) Prospective validation of the SCAI shock classification: Single center analysis , Catheterization and Cardiovascular Interventions, 10.1002/ccd.29319, 96:7, (1339-1347), Online publication date: 1-Dec-2020. Tehrani B, Truesdell A, Psotka M, Rosner C, Singh R, Sinha S, Damluji A and Batchelor W (2020) A Standardized and Comprehensive Approach to the Management of Cardiogenic Shock, JACC: Heart Failure, 10.1016/j.jchf.2020.09.005, 8:11, (879-891), Online publication date: 1-Nov-2020. Fang J and Jones T (2020) Can a Pulmonary Artery Catheter Improve Outcomes in Cardiogenic Shock?, JACC: Heart Failure, 10.1016/j.jchf.2020.08.013, 8:11, (914-916), Online publication date: 1-Nov-2020. Tehrani B, Basir M and Kapur N (2020) Acute myocardial infarction and cardiogenic shock: Should we unload the ventricle before percutaneous coronary intervention?, Progress in Cardiovascular Diseases, 10.1016/j.pcad.2020.09.001, 63:5, (607-622), Online publication date: 1-Sep-2020. Eschenroeder L, Nguyen V, Neradilek M, Li S and Dardas T (2020) Patterns of Hospital Bypass and Interhospital Transfer Among Patients With Heart Failure, Journal of Cardiac Failure, 10.1016/j.cardfail.2020.04.015, 26:9, (762-768), Online publication date: 1-Sep-2020. Anstey D, Givens R, Clerkin K, Fried J, Kalcheva N, Kumaraiah D, Masoumi A, O'Connor D, Rosner G, Wasson L, Hammond J, Kirtane A, Uriel N, Schwartz A, Rabbani L and Abdalla M (2020) The cardiac intensive care unit and the cardiac intensivist during the COVID-19 surge in New York City, American Heart Journal, 10.1016/j.ahj.2020.06.018, 227, (74-81), Online publication date: 1-Sep-2020. Alvarez P and Hernandez-Montfort J (2020) Shock Team Approaches in Managing Cardiogenic Shock—Intersection Between Critical Care and Advanced Heart Failure and Transplant Cardiology, Current Treatment Options in Cardiovascular Medicine, 10.1007/s11936-020-00820-2, 22:9, Online publication date: 1-Sep-2020. Schrage B, Dabboura S, Yan I, Hilal R, Neumann J, Sörensen N, Goßling A, Becher P, Grahn H, Wagner T, Seiffert M, Kluge S, Reichenspurner H, Blankenberg S and Westermann D (2020) Application of the SCAI classification in a cohort of patients with cardiogenic shock, Catheterization and Cardiovascular Interventions, 10.1002/ccd.28707, 96:3, Online publication date: 1-Sep-2020. Luk A, Wang V, Almazroa L, Foroutan F, Huebener N, Hillyer A, Billia F, Ross H and Overgaard C (2020) Management of Acute Decompensated Heart Failure in the Cardiac Intensive Care Unit: The Importance of Co-management With a Heart Failure Specialist, CJC Open, 10.1016/j.cjco.2020.02.010, 2:4, (229-235), Online publication date: 1-Jul-2020. Schrage B, Weimann J, Dabboura S, Yan I, Hilal R, Becher P, Seiffert M, Bernhardt A, Kluge S, Reichenspurner H, Blankenberg S and Westermann D (2020) Patient Characteristics, Treatment and Outcome in Non-Ischemic vs. Ischemic Cardiogenic Shock, Journal of Clinical Medicine, 10.3390/jcm9040931, 9:4, (931) Kim D (2020) Mechanical Circulatory Support in Cardiogenic Shock: Shock Team or Bust?, Canadian Journal of Cardiology, 10.1016/j.cjca.2019.11.001, 36:2, (197-204), Online publication date: 1-Feb-2020. Tandar A and Drakos S (2019) Cardiogenic shock in aortic stenosis patients: Balancing between complexity and simplicity, Hellenic Journal of Cardiology, 10.1016/j.hjc.2019.06.002, 60:3, (182-184), Online publication date: 1-May-2019. July 2, 2019Vol 140, Issue 1 Advertisement Article InformationMetrics © 2019 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.119.040654PMID: 31549877 Originally publishedJuly 1, 2019 Keywordsmyocardial infarctionintensive care unitssurvival analysisheart failureshock, cardiogenicPDF download Advertisement SubjectsCardiomyopathyCardiopulmonary Resuscitation and Emergency Cardiac CareClinical StudiesHeart FailureMyocardial Infarction