Mechanical Circulatory Support in Cardiogenic Shock: Shock team or Bust?

Publication date: Available online 9 November 2019Source: Canadian Journal of CardiologyAuthor(s): Daniel H. KimAbstractCardiogenic Shock (CS) accounts for 15% of all Cardiac Intensive Care Unit admissions, with Acute Myocardial Infarction Cardiogenic Shock (AMICS) accounting for 30% of these. In contrast to other areas in cardiac care where survival has continued to improve over the last two decades, CS still carries a mortality of around 40%. Temporary Mechanical Circulatory Support (tMCS) therapies have shown inconsistent results in improving outcomes in CS, with the overall evidence not supporting its use, at least not in unselected patients. Some of the main stumbling blocks leading to disappointing results of tMCS in CS are: 1) Challenging patient identification and selection; 2) Delayed timing; 3) Lack of a systematic approach; 4) Inappropriate utilization of adjunct therapies and tools; 5) Lack of escalation/de-escalation and long-term planning; 6) Disparities in regional/center access to MCS. Among the most promising solutions to this challenge, is the Cardiogenic Shock Team (CST), which takes a standardized multidisciplinary approach to the acute management of CS. This paradigm brings expertise from Advanced Heart Failure, Interventional Cardiology, Cardiac Surgery, Cardiac Intensive Care, Nursing and others to effectively address all of the issues aforementioned. Unsurprisingly, hurdles to implementation exist, such as establishing effective team dynamics, maintena...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research