Bringing The Swan Back: Improving Cardiogenic Shock Mortality

Abstract

<h3>Background</h3> Mortality in cardiogenic shock is historically high, with advances in devices and mechanical cardio-circulatory support treatment is improving. Institutional recognition and implementation is of utmost importance. <h3>Objective</h3> To create early multidisciplinary activation of hemodynamic-guided management which includes early shock identification and implementation of mechanical circulatory support to improve the outcomes of cardiogenic shock patients at a non-tertiary care hospital. <h3>Methods</h3> A single-center, retrospective study was performed on patients who presented with cardiogenic shock secondary to acute decompensated heart failure or acute myocardial infarction between 2016-2020. Use of mechanical support including Impella and intra-aortic balloon pump as well as the use of Swan-Ganz catheters were examined. Endpoints of survival to discharge were also examined. <h3>Results</h3> A total of 209 patients presented with cardiogenic shock over a 5 year period. Data analysis showed that compared to baseline 2016 survival data of 37% (10/27), survival rates increased every year to 43%(12/28) in 2017, 54%(14/26) in 2018, 70 %(40/57) in 2019, and 71% (51/72) in 2020 (p= 0.001; OR 25.22; CI 3.55 to 179.23), facilitated by the implementation of a multidisciplinary cardiogenic shock team in 2018. In addition, the use of Swan-Ganz catheters substantially increased from 0% in 2016 to 100% in 2019. Specifically between 2018 and 2019, Swan-Ganz catheter usage increased from 43% in 2018 to 100% in 2019 as did survival percentage (54% to 71%) (p=0.06). The use of mechanical support increased from 9 patients in 2016 to 35 patients in 2020. The survival to discharge of patients requiring Impella support increased from 17% in 2018 to 67% in 2020. <h3>Conclusions</h3> The results of this study demonstrate that a multidisciplinary team approach to the treatment of cardiogenic shock resulted in better clinical outcomes. Survival to discharge improved substantially from 2016 to 2020. These improved outcomes were driven by a combination of a multidisciplinary team approach, utilization of Swan-Ganz catheters, and effective use of mechanical support devices.