. 2021 Jan 16;8(2):988–998. doi: 10.1002/ehf2.13180

Table 1.

Studies to date using dedicated cardiogenic shock teams and protocols

Study	Number of patients	Quality Measures/Goals	Intervention(s)	Outcome(s)
National Cardiogenic Shock Initiative ⁶⁰ Basir et al. 2019 Prospective single‐arm study	Total: 171 All patients with AMI‐CS *No control group	1. MCS use pre‐PCI 2. Shock onset to device <90 min 3. Establish TIMI 3 Flow 4. Complete revascularization 5. Maintain CPO > 0.6 W 6. Maintain PAPi >0.9 7. Routine RHC use	PCI: 171 of 171 patients MCS [Impella 2.5, CP, or RP]: 169 of 171 pts • 74% pre‐PCI • 7.1% during PCI • 18.9% post‐PCI RHC: 154 of 171 pts	MCS pre‐PCI: 74% RHC usage: 92% Maintain CPO > 0.6 W: 62% Door to support time: 85 ± 63 min Survival to discharge: 72%
Inova Heart and Vascular Institute Cardiogenic Shock Initiative ⁴⁶ Tehrani et al. 2019 Prospective, pre‐intervention and post‐intervention study	Total: 204 AMI‐CS: 81 ADHF‐CS: 122 *Control group not presented	1. Rapid CS identification 2. Early MCS (LV and RV) 3. RHC: Thresholds at 24 h: i. Lactate <3 ii. CPO >0.6 W iii. PAPi >1.0 4. Minimize inotropes/vasopressors 5. Cardiac recovery	PCI: 82 of 204 patients MCS: 135 of 204 pts • 35.3% IABP • 44.9% Impella only • 6.4% VA‐ECMO only • 13.5% Impella + VA‐ECMO RHC: 167 of 204 patients	30 day survival: • Pre‐shock team implementation: 47% • After 1 year of shock team implementation: 58% • After 2 years of shock team implementation: 77% (P < 0.01)
Utah Cardiac Recovery shock team ⁶¹ Taleb et al. 2019 Prospective, pre‐intervention and post‐intervention study	Total: 244 N = 123 treatment; N = 121 control AMI‐CS: N _treatment = 75 N _control = 85 Non‐AMI CS: N _treatment = 48 N _control = 36	If STEMI: 1. Central arterial access for LVEDP measurement 2. Consideration for MCS and simultaneous angiogram‐PCI 3. Urgent RHC If not STEMI: 1. Urgent RHC 2. Consideration for MCS 3. Possible LHC as needed	MCS: 123 of 123 in shock team (vs. control) • 30.2% IABP (vs. 62.8%) • 33.3% Impella (vs. 9.9%) • 8.9% VA‐ECMO (vs. 5%) • 27.6% combination of devices (vs.. 22.3%) P value for MCS type <0.001	Shock to support time: 19 ± 5 (vs. 25 ± 8 h, P = NS) Mean length of MCS support: 121 ± 13 (vs. 104 ± 16 h, P = NS) In‐hospital survival: 61% (vs. 47.9%; P = 0.04) 30 day all‐cause mortality HR 0.61 [95% CI, 0.41–0.93]
University of Ottawa Heart Institute code shock team ⁴⁷ Lee et al. 2020 Retrospective, CPO, MCS, PAPi, RHC pre‐intervention and post‐intervention study	Total: 100 N _treatment = 64 N _control = 36 AMI‐CS: N _treatment = 7 N _control = 6 Non‐AMI CS: N _treatment = 57 N _control = 30	1. Confirmation of CS 2. Resuscitation 3. Medical optimization 4. Temporary MCS evaluation 5. Heart transplant, LVAD evaluation	Revascularization: 12 of 100 patients—all AMI‐CS (75% PCI, 8% CABG, 17% both) MCS: 29 of 64 in shock team (vs. 10 of 36 in control) • 34% IABP (vs. 40%) • 28% Impella (vs. 10%) • 7% VA‐ECMO (vs. 10%) • 14% combination (vs. 11%) P value for MCS type: 0.08 RHC: 50 of 100 patients	Temporary MCS use: 45% (vs. 28%, P = 0.08) In‐hospital survival: 69% (vs. 61%; P = NS) 30 day survival: 72% (vs. 69%; P = NS) Long‐term survival: 67% (vs. 42%; P = 0.04) Cumulative survival: HR 0.53 [95% CI 0.28–0.99]

Study

Number of patients

Quality Measures/Goals

Intervention(s)

Outcome(s)

National Cardiogenic Shock Initiative ⁶⁰

Basir et al. 2019

Prospective single‐arm study

Total: 171

All patients with AMI‐CS

*No control group

1. MCS use pre‐PCI

2. Shock onset to device <90 min

3. Establish TIMI 3 Flow

4. Complete revascularization

5. Maintain CPO > 0.6 W

6. Maintain PAPi >0.9

7. Routine RHC use

PCI: 171 of 171 patients

MCS [Impella 2.5, CP, or RP]: 169 of 171 pts

• 74% pre‐PCI

• 7.1% during PCI

• 18.9% post‐PCI

RHC: 154 of 171 pts

MCS pre‐PCI: 74%

RHC usage: 92%

Maintain CPO > 0.6 W: 62%

Door to support time:

85 ± 63 min

Survival to discharge: 72%

Inova Heart and Vascular Institute Cardiogenic Shock Initiative ⁴⁶

Tehrani et al. 2019

Prospective, pre‐intervention and post‐intervention study

Total: 204

AMI‐CS: 81

ADHF‐CS: 122

*Control group not presented

1. Rapid CS identification

2. Early MCS (LV and RV)

3. RHC: Thresholds at 24 h:

i. Lactate <3

ii. CPO >0.6 W

iii. PAPi >1.0

4. Minimize inotropes/vasopressors

5. Cardiac recovery

PCI: 82 of 204 patients

MCS: 135 of 204 pts

• 35.3% IABP

• 44.9% Impella only

• 6.4% VA‐ECMO only

• 13.5% Impella + VA‐ECMO

RHC: 167 of 204 patients

30 day survival:

• Pre‐shock team implementation: 47%

• After 1 year of shock team implementation: 58%

• After 2 years of shock team implementation: 77% (P < 0.01)

Utah Cardiac Recovery shock team ⁶¹

Taleb et al. 2019

Prospective, pre‐intervention and post‐intervention study

Total: 244

N = 123 treatment; N = 121 control

AMI‐CS:

N _treatment = 75 N _control = 85

Non‐AMI CS:

N _treatment = 48

N _control = 36

If STEMI:

1. Central arterial access for LVEDP measurement

2. Consideration for MCS and simultaneous angiogram‐PCI

3. Urgent RHC

If not STEMI:

1. Urgent RHC

2. Consideration for MCS

3. Possible LHC as needed

MCS: 123 of 123 in shock team (vs. control)

• 30.2% IABP (vs. 62.8%)

• 33.3% Impella (vs. 9.9%)

• 8.9% VA‐ECMO (vs. 5%)

• 27.6% combination of devices (vs.. 22.3%)

P value for MCS type <0.001

Shock to support time: 19 ± 5 (vs. 25 ± 8 h, P = NS)

Mean length of MCS support: 121 ± 13 (vs. 104 ± 16 h, P = NS)

In‐hospital survival: 61% (vs. 47.9%; P = 0.04)

30 day all‐cause mortality HR 0.61 [95% CI, 0.41–0.93]

University of Ottawa Heart Institute code shock team ⁴⁷

Lee et al. 2020

Retrospective, CPO, MCS, PAPi, RHC

pre‐intervention and post‐intervention study

Total: 100

N _treatment = 64 N _control = 36

AMI‐CS:

N _treatment = 7

N _control = 6

Non‐AMI CS:

N _treatment = 57

N _control = 30

1. Confirmation of CS

2. Resuscitation

3. Medical optimization

4. Temporary MCS evaluation

5. Heart transplant, LVAD evaluation

Revascularization: 12 of 100 patients—all AMI‐CS (75% PCI, 8% CABG, 17% both)

MCS: 29 of 64 in shock team (vs. 10 of 36 in control)

• 34% IABP (vs. 40%)

• 28% Impella (vs. 10%)

• 7% VA‐ECMO (vs. 10%)

• 14% combination (vs. 11%)

P value for MCS type: 0.08

RHC: 50 of 100 patients

Temporary MCS use: 45% (vs. 28%, P = 0.08)

In‐hospital survival: 69% (vs. 61%; P = NS)

30 day survival: 72% (vs. 69%; P = NS)

Long‐term survival: 67% (vs. 42%; P = 0.04)

Cumulative survival: HR 0.53 [95% CI 0.28–0.99]

AMI, acute myocardial infarction; CABG, coronary artery bypass graft; CI, confidence interval; CPO, cardiac power output; CS, cardiogenic shock; HR, hazard ratio; IABP, intra‐aortic balloon pump; LVAD, left ventricular assist device; MCS, mechanical circulatory support; NS, not significant; PAPi, pulmonary artery pulsatility index; PCI, primary coronary intervention; RHC, right heart catheterization; VA‐ECMO, venoarterial extracorporeal membrane oxygenation.