Multidisciplinary Code Shock Team in Cardiogenic Shock: a Canadian-center experience

Abstract Background Cardiogenic shock (CS) is associated with high mortality. We report on a ‘Shock Team’ approach of combined interdisciplinary expertise for decision making, expedited assessment and treatment. Methods and Results We reviewed 100 patients admitted in CS over 52 months. Patients managed under a Code Shock Team protocol (n=64, treatment) during 2016-2019 were compared to standard care (n=36, control) during 2015-2016. The cohort was predominantly male (78% treatment, 67% control) with a median age 55 years (IQR 43,64) for treatment versus 64 years (IQR 48,69) for control (p=0.01). New heart failure was more common in the treatment group: 61% vs. 36%, p=0.02. Acute myocardial infarction comprised 13% of CS patients. There were no significant differences between treatment versus control in markers of clinical acuity including median left ventricular ejection fraction (18% vs. 20%), prevalence of moderate-severe right ventricular dysfunction (64% vs. 56%), median peak serum lactate (5.3mmol/L vs. 4.7mmol/L), acute kidney injury (70% vs. 75%) or acute liver injury (50% vs. 31%). Inotropes, dialysis and invasive ventilation were required in 92%, 33% and 66% of patients respectively. Temporary mechanical circulatory support was utilized in 45% treatment and 28% control patients (p=0.08). There were no significant differences in median hospital length-of-stay (17.5 days), 30-day survival (71%) or survival-to-hospital discharge (66%). Over 240 days (IQR 14,847) median follow-up, survival was 67% for treatment versus 42% for control: HR 0.53; 95% CI 0.28-0.99, p=0.03. Conclusion A multidisciplinary Code Shock Team approach for CS is feasible and may be associated with improved long-term survival.