Shock Team Research Articles

'Combat' Approach to Cardiogenic Shock.

The incidence of cardiogenic shock is rising, patient complexity is increasing and patient survival has plateaued. Mirroring organisational innovations of elite military units, our multidisciplinary medical specialists at the INOVA Heart and Vascular Institute aim to combine the adaptability, agility and cohesion of small teams across our large healthcare system. We advocate for widespread adoption of our 'combat' methodology focused on: increased disease awareness, early multidisciplinary shock team activation, group decision-making, rapid initiation of mechanical circulatory support (as appropriate), haemodynamic-guided management, strict protocol adherence, complete data capture and regular after action reviews, with a goal of ending preventable death from cardiogenic shock.

(761) - Role of a Multidisciplinary Shock Team in the Management of Cardiogenic Shock

(761) - Role of a Multidisciplinary Shock Team in the Management of Cardiogenic Shock

(127) - A Shock Team Improves Survival in Cardiogenic Shock by Decreasing Time to Intervention

(127) - A Shock Team Improves Survival in Cardiogenic Shock by Decreasing Time to Intervention

A team-based approach to patients in cardiogenic shock.

Cardiogenic shock is a common clinical condition with high in-hospital mortality. Early application of appropriate interventions for cardiogenic shock-including medical therapies, revascularization, temporary hemodynamic support devices, and durable mechanical circulatory support-may improve outcomes. The number and complexity of therapies for cardiogenic shock are increasing, making time-dependent decision-making more challenging. A multidisciplinary cardiogenic shock team is recommended to guide the rapid and efficient use of these available treatments. © 2015 Wiley Periodicals, Inc.

Scottish audit of interhospital transfers of acutely ill adults

The audit was commissioned by the Scottish Government Health Department to identify the number of acutely ill adults transported between hospitals by the Scottish Ambulance Service (SAS). Currently interhospital transfer (IHT) of acutely ill adults requiring medical escorts is undertaken by the SAS Accident and Emergency (A&E) ambulances or by dedicated transport teams (for example, Glasgow Shock Team and Emergency Medical Retrieval Service).

Analysis of critical incidents during the interhospital transport of critically ill patients

In this study we created a database to analyse the incidence and types of critical incidents that occurred during the interhospital transfer of critically ill patients. The transfer of critically ill patients presents important risks and the safety of patients has been shown to be facilitated by the development of standard equipment and specialist teams [1]. The West of Scotland Shock team is a designated regional transfer service based in Glasgow. We are involved in the interhospital transfer of patients and not primary retrieval. A recent study looking at critical incidents during the intrahospital transport of the critically ill highlighted the risks posed, and recommended the monitoring of incidents in order to aid the continuous improvement in patient safety [2]. No similar study has been carried out looking at the interhospital transport of the critically ill patient.

Management of sepsis and septic shock in critically ill patients transferred by a dedicated transport team in the West of Scotland

Over 500 critically ill patients are transferred by the dedicated transport team known as the 'Shock Team' each year in the West of Scotland. With the advent of international guidelines for the management of severe sepsis and septic shock, there are now criteria by which the management of these conditions can be assessed [1]. We undertook a prospective audit over a 3-month period to determine what proportion of the patients transferred have these conditions and to determine how management conforms to the guidelines. Patients were deemed to have sepsis if they had suspicion of infection and two or more of the following: T >38°C or 12 × 103/mm3; HR >90/min; RR >20/min; SBP <90 mmHg or MAP <65 mmHg or needing a vasopressor. We adapted sepsis resuscitation bundles derived from the guidelines [2] and devised a data collection form with relation to the following: serum lactate measurement; blood cultures prior to antibiotics; antibiotics given within 3 hours; MAP <65 mmHg and management with a minimum 20 ml/kg fluid challenge, vaso-pressors, and CVP monitoring; achievement of MAP ≥ 65 mmHg; measurement of central venous oxygen saturation (ScvO2). Data were collected for every patient transferred during June, July, and August 2005. Data were collected for 82 patients. Forty-five patients (55%, 95% CI 44–66%) met criteria for sepsis. Of these, eight patients had blood cultures prior to antibiotics (18%, 95% CI 8–32%), and in 23 (51%, 95% CI 35–66%) this information was not available or unclear. Similarly, 24 patients (53%, 95% CI 28–68%) had antibiotics within the time window, and in 17 (38%, 95% CI 24–54%) this was unclear. Twenty-eight (62%, 95% CI 47–76%) patients had circulatory failure with 19 of these (68%, 95% CI 48–84%) requiring more than a fluid challenge alone. MAP ≥ 65 mmHg was achieved in 43 patients (96%, 95% CI 85–100%). Two patients with sepsis had serum lactate measured (4%, 95% CI 0.5–15%). One patient of the 19 who had not responded to a fluid challenge had ScvO2 measurement (5%, 95% CI 0–26%). A significant number of critically ill patients with sepsis and septic shock are transferred each year. Many have circulatory failure and this is managed consistently with fluids, vasopressor and CVP targeting. Documentation and communication of blood culture withdrawal and antibiotic therapy may be poor. Serum lactate and ScvO2 measurement may not yet be part of routine management of patients with sepsis transported in the West of Scotland.

A Multidisciplinary Community Hospital Program for Early and Rapid Resuscitation of Shock in Nontrauma Patients

To determine the effect of a community hospital-wide program enabling nurses and prehospital personnel to mobilize institutional resources for the treatment of patients with nontraumatic shock. Historically controlled single-center study. A 180-bed community hospital. Patients in shock who were candidates for aggressive therapy. From January 1998 to May 31, 2000, patients in shock received standard therapy (control group). During the month of June 2000, intensive education of all health-care providers (ie, prehospital personnel, nurses, and physicians) took place. From July 1, 2000, through June 30, 2001, patients in shock (protocol group) were managed with a hospital-wide shock program. The program included early recognition of shock and the initiation of therapy by nonphysicians. Frontline personnel mobilized a shock team, which used goal-directed resuscitation protocols, early intensivist involvement, and rapid transfer to the ICU where protocols specific to shock etiology were implemented. Eighty-six and 103 patients, respectively, were enrolled in the control and protocol groups. Baseline characteristics were similar. The protocol group had significant reductions in the median times to interventions, as follows: intensivist arrival, 2:00 h to 50 min (p < 0.002); ICU/operating room admission, 2 h 47 min to 1 h 30 min (p < 0.002); 2 L fluid infused, 3 h 52 min to 1 h 45 min (p < 0.0001); and pulmonary artery catheter placement, 3 h 50 min to 2 h 10 min (p 0.02). Good outcomes (ie, discharged to home or to a rehabilitation center) were more likely in the protocol group than in the control group (p = 0.02). The hospital mortality rate was 40.7% in the control group and 28.2% in the protocol group (p = 0.035). Similar to current practice in patients who have experienced trauma or cardiac arrest, the empowerment of nonphysician providers to mobilize hospital resources for the care of patients with shock is effective. A community hospital program incorporating the education of providers, the activation of a coordinated team response, and early goal-directed therapy expedited appropriate treatment and was temporally associated with improved outcomes. Randomized multicenter trials are needed to further assess the impact of the shock program on outcomes.

The incidence of the shock syndrome in a general hospital.

Summary During a 1-year period (May 1971-May 1972), patients developing the shock syndrome in a large general hospital were referred to a multi-disciplinary shock team. Sepsis, haemorrhage and severe hypoxaemia were the principal precipitating factors. Mortality exceeded 70% in the septic and cardiogenic shock series and was lowest in shock attributable to fluid depletion and drug overdose. Whereas improvement in mortality in the haemorrhagic shock group is likely to result from more rapid and aggressive primary surgery, septic shock, particularly arising from intestinal complications, will require a more complex solution. A shock team seems an important addition to the services of a modern general hospital.