Clinical Nurse Specialist St. Paul's Hospital, British Columbia, Canada
Background: Cardiogenic shock is defined by the presence of reduced cardiac output resulting in impaired organ perfusion. Despite advances in cardiac interventions, device therapy and critical care over the past 50 years, the mortality for patients with cardiogenic shock remains as high as 50%. Multidisciplinary cardiogenic shock teams (CGST) have been shown in observational studies as one of the only interventions to improve mortality in this group of critically ill patients.
METHODS AND RESULTS: We detail our journey in developing a CGST here at St. Paul’s Hospital from inception (March 2023) to the start of pilot trial (April 2024). We used existing hospital resources (Teams application through switchboard) to rapidly launch this pilot project. Quarterly case reviews were performed with further fine-tuning of the activation criteria and to identify areas for improvement. Small incremental changes were made over the past year including physician and nursing education, clarification of activation criteria and feedback based on patient outcomes. Our pilot project focused on identifying patients in SCAI class C-D shock who have failed initial medical stabilization.
From April 2024 to March 2025, there were a total of 12 shock team activations with median patient age of 59 years and 8 of 12 patients were women. Etiology of shock consisted of 4 acute myocardial infarction shock (33%), 3 myocarditis (25%), 2 congenital heart disease (17%) and 3 from other etiologies (post-partum, constriction and post-cardiotomy shock). Shock team meetings led to pulmonary artery catheterization (PAC) in 7/12 (58%) of the patients and change in clinical diagnosis or decision making in 4/12 (33%) of the patients including changes in the classification of shock. Mechanical circulatory support (MCS) was instituted in 7/12 (58%) of patients with 3 receiving VA ECMO, 2 receiving microaxial flow pump device and 2 receiving IABP. Overall, 9/12 (75%) patients survived to discharge and 4/12 (33%) bridged to advanced heart failure therapy (transplant or left ventricular assist device).
Conclusion: Cardiogenic shock team (CGST) activation was associated with high use of PAC (58%), MCS (58%) and resulted in changes in clinical diagnosis or management (>33%). The overall survival rate was 75% with 33% of patients bridged to advanced heart failure therapy. This pilot study shows the feasibility of rapidly implementing a CGST using a quality improvement model. Ongoing quality review and incremental improvements will be required to further assess the CGST’s potential benefit in improving mortality for cardiogenic shock patients.
