Table 1.

Clinical studies evaluating outcomes in cardiogenic shock after implementation of standardized team-based approach.

Studies	Study design	Number of patients	Shock phenotype	Goals		Interventions	Outcomes	Predictors for mortality
Inova Heart and Vascular Institute Cardiogenic Shock Initiative (11)	Prospective single center (pre- and post-intervention) Compared Shock team vs. historical control	Total = 204 AMI-CS = 81 HF-CS = 122	AMI-CS and HF-CS	a.Rapid CS recognition b.Early MCS c.RHC thresholds after 24h: lactate <3, CPO >0.6W, PAPi >1.0		PCI: 40% RHC: 82% MCS use 66%	a.30-day survival (p < 0.01): 47% (pre-CS team) to 77% at 2 years.	IHVI risk score: 1.Age ≥71 2.DM 3.Dialysis 4.≥36 h of vasopressor use At 24 h: 5.Lactate ≥3.0 mg/dl 6.CPO <0.6 W 7.PAPi <1.0 Score (30-day mortality) Low: 0–1 (0%), Moderate: 2–4 (18%) High: 5+ (82%)
University of Utah Cardiac Recovery shock team (13)	Prospective single center (pre- and post-intervention) Compared shock team vs. historical control group	Total = 244 AMI-CS = 160 Non-AMI CS = 84	AMI-CS, HF-CS	STEMI a.LVEDP b.LHC +/- PCI c.tMCS consideration d.Urgent RHC	Non-STEMI a.Urgent RHC b.tMCS consideration c.+/- LHC	MCS use: 50% (all shock team patients) -IABP: 30% -Impella: 33% -VA-ECMO: 9% -Combination: 28%	a.Increased in-hospital survival (61% vs. 48%, p 0.04) b.Decreased 30-day all-cause mortality (HR 0.61, 95% CI: 0.41–0.93) c.Shock to support time and mean duration of MCS was not significant	AMI-CS, lactate level, and acute kidney injury were independent risk factors of 30-day mortality at the time of MCS initiation
University of Ottawa Heart Institute code shock team (14)	Retrospective single- center (pre- and post-intervention) Compared shock team vs. historical controls	Total = 100 AMI-CS = 13 Non-AMI CS = 87	AMI-CS, HF-CS	a.CS identification and confirmation b.Resuscitation and medical optimization c.tMCS evaluation and initiation d.OHT, LVAD evaluation		PCI: 9% CABG: 1% MCS: 45% (vs. 28% control) PAC monitoring: 62%	a.In-hospital survival 69% vs. 61% (p = NS) b.30-day survival 72% vs. 69% (p = NS) c.Increased cumulative survival (HR = 0.53, 95% CI: 0.28–0.99, p = 0.03)	–
National Cardiogenic Shock Initiative (12)	Prospective multicenter study Single arm without controls	Total = 171 AMI-CS = 171 Non-AMI CS were not included	AMI-CS only	a.Early identification of CS RHC hemodynamics b.MCS use pre-PCI c.Shock to support time <90 mins d.Ensure TIMI 3 flow e.Complete revascularization f.CPO >0.6 W g.PAPi >0.9		PCI: 100% MCS: 99% -74% pre-PCI -7% during PCI -19% post-PCI RHC: 90%	a.Survival to discharge 72% b.Maintained CPO >0.6 W in 62% c.Door to support time: 85 ± 61 min	Predictors of increased in-hospital mortality 1.Age ≥70 2.Creatinine ≥2 3.Lactate ≥4 4.CPO <0.6
Critical Care Cardiology Trials Network (98)	Prospective multicenter study Compared CICUs with vs. without shock teams	Total = 1,242 -Shock team: 44% -No shock team: 56% AMI-CS = 27% Non-AMI CS = 73%	AMI-CS, HF-CS	a.Rapid identification of CS etiology (AMI vs. non-AMI) and phenotype (LV, RV, BiV) b.tMCS use (type of and total number) c.PAC use d.SOFA score, lactate, and creatinine on CICU admission		Centers with Shock team (vs. without) MCS use: -Overall: 35% (vs. 43%) -Within first 24 h: 60% (vs. 52%) -IABP 58% (vs. 72%) -Impella 28% (vs. 16%) -VA-ECMO 9% (vs. 11%) -PAC use: 60% (vs. 49%)	Center with shock teams (vs. without) a.CICU mortality 23% (vs. 29%, p = 0.016) b.Advanced MCS use 53% (vs. 43%, p = 0.005) c.New RRT 11% (vs. 19%, p < 0.001)	Presence of shock team was independently associated with lower CICU mortality

AMI-CS, acute myocardial infarction complicated by cardiogenic shock; CICU, cardiac intensive care unit; CPO, cardiac power output; CS, cardiogenic shock; DM, diabetes mellitus; HF-CS, heart failure complicated by cardiogenic shock; HR, hazard ratio; IABP, intra-aortic balloon pump; LVEDP, left ventricular end-diastolic pressure; LHC, left heart catheterization; LVAD, left ventricular assist device; MCS, mechanical circulatory support; NS, nonsignificant; OHT, orthotopic heart transplantation; PAC, pulmonary artery catheter; PCI, percutaneous coronary intervention; PAPi, pulmonary arterial pulsatility index; pVAD, percutaneous ventricular assist device; RHC, right heart catheterization; RRT, renal replacement therapy; STEMI, ST-elevation myocardial infarction; VA-ECMO, veno-arterial extra corporeal membrane oxygenation; W, watts.