SHOCK1: Penn Medicine Multidisciplinary Shock Team Model for Improved Outcomes in Cardiogenic Shock and Temporary Mechanical Circulatory Support

Abstract

Purpose/Background: The implementation of a protocol-based, multidisciplinary shock team approach in tertiary centers can lead to an organized approach to care and early implementation of temporary mechanical circulatory support (tMCS) in the appropriate patient. The Penn Medicine Cardiogenic Shock Team (PMCST) was established in November 2019. We have reviewed our data to demonstrate the utility and viability of the PMCST model by highlighting improved outcomes in our patient population compared to published outcomes in the literature. Methods: We collected data on our shock team since its inception from 11/2019-1/2023. These data include review of patient profiles, tMCS use, and outcomes of our shock patients, including overall disposition as well as disposition after tMCS. Results: From 11/25/2019-1/15/2023, our team had 498 total shock calls. Three hundred and forty-three (69%) were accepted by our shock team (“Go”) and included in our analysis. One hundred and sixty did not meet criteria (“No Go”), most commonly because they were not candidates for advanced support. All patients were characterized by SCAI and Intermacs classifications as well as shock etiology. The largest number of accepted patients were SCAI D (131), followed by SCAI C (105) and E (83), respectively. Eighty-nine percent of patients fell into Intermacs classifications 1-3, with the highest number of Intermacs 2 patients at 132. The predominant diagnosis was Acute Decompensated Heart Failure-Cardiogenic Shock (ADHF-CS) in 111 patients (32%), with 67 patients (20%) diagnosed with Acute Myocardial Infarction Cardiogenic Shock (AMI-CS). Our team also accepted 17 patients with diagnoses related to ventricular tachycardia (VT storm, recurrent VT). Shock team calls were predominantly outside hospital (OSH) referrals (93%), and the remaining 7% were internal consults to the PMCST. Of accepted OSH patients, 143 had tMCS present on arrival, with the majority being intra-aortic balloon pump (IABP) and Impella CP, while 183 patients utilized tMCS during admission. Multiple tMCS devices were used concomitantly in 61 patients, the majority of whom with either ECPella (Impella CP and VA-ECMO) or IABP with VA-ECMO at 37% and 28%, respectively. In patients requiring tMCS, 104 (57%) remain alive, 91 (69%) of whom have since been discharged. With regard to our 343 accepted shock team patients, 240 (70%) remain alive, while 230 (67%) of whom were discharged alive. Summary: Our results show that a multidisciplinary shock team model represents a successful strategy leading to a multidisciplinary approach to care and timely deployment of tMCS. These data suggest the PMCST model leads to improved outcomes in patients with cardiogenic shock.Figure 1. Disposition of PMCST Shock PatientsFigure 2. Types of Concomitant tMCS Utilized in PMCST Patients