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Feasibility and Effectiveness of a Multidisciplinary Team Approach in Refractory Cardiogenic Shock Requiring Mechanical Circulatory Support: A Pilot Prospective Study

Byung-Soo Ko, Iosif Taleb, Ryan Larsen, Anwar Tandar, Tae Soo Kang, Stephen McKellar, Josef Stehlik, Greg Stoddard, Antigone Koliopoulou, Edward M. Gilbert, Jose Nativi-Nicolau, James Fang, Craig Selzman, Frederick Welt, Stavros G. Drakos
The diversity in both the etiology and the clinical course of refractory cardiogenic shock makes the management of this critical condition challenging. Although a multidisciplinary team based approach has been recommended, it has not been widely adopted. We sought to investigate the feasibility and effectiveness of a multidisciplinary team approach in patients with RCS. A multidisciplinary “SHOCK TEAM”, comprised of a heart failure cardiologist, an interventional cardiologist, an intensivist, and a cardiothoracic surgeon, was established in April 2015 as a part of the Utah Cardiac Recovery-SHOCK program. The program prospectively investigates the management and outcomes of consecutive RCS patients who (i) require temporary percutaneous mechanical circulatory support (MCS) based on predefined criteria and clinical protocol, and (ii) are being managed by the SHOCK TEAM. Nineteen patients who have been enrolled since the launch of the program were compared with the immediately preceding 40 consecutive patients who presented with RCS requiring percutaneous MCS (control group). Baseline characteristics including age (56 vs. 55 in control), comorbidities, presenting hemodynamics, duration of shock before reaching the tertiary care center were comparable between the two groups. We found a marginally significant lower 30-day mortality in the SHOCK TEAM group in a Cox regression model (38.9% vs. 60% in control group; HR, 0.65, p=0.07). ICU stay and hospital stay also tended to be shorter in the SHOCK TEAM group (mean ± SD, 13 ± 13 vs. 27 ± 59 days in control, p=0.33 and 16 ± 15 vs. 31 ± 59 days in control, p=0.30). Furthermore, “Door-to-MCS implementation” time was compared between the groups to evaluate whether the team approach would lead to delays in management, and there was no significant difference. A multidisciplinary shock team approach seems to be feasible, practical, and may improve outcomes of patients with RCS.

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