Implementation of a Multidisciplinary Cardiogenic Shock Team in a Nonacademic Canadian Heart Centre: An Implementation Study.

Background: In this study we evaluated our ability to implement team-based cardiogenic shock (CS-Team), focussing on: 1) early screening; 2) CS-Team activation; and 3) use of invasive monitoring to guide therapy. Methods: All patients admitted to the coronary care unit (CCU) over 12 months were screened for CS. A diagnosis of CS was made when both hypotension and hypoperfusion were present. The CS-Team was composed of the CCU attending, an interventional cardiologist, and a cardiac surgeon. Multivariate analysis was carried out with mortality as the outcome of interest. Results: Screening was documented in 74% (1160 of 1562) of patients admitted to a critical care unit; of these, 1080 were not in CS. We identified 80 patients in CS (Society for Cardiovascular Angiography & Interventions [SCAI] stages C-E), which represented 6.9% of all screened patients. Patients in CS had significantly higher in-hospital mortality (35% vs 2%, Conclusions: We found that: 1) early screening by frontline staff was feasible but had limitations (26% screening failure); 2) CS-Team activation appeared discretionary (limited activation to 45% of patients); and 3) CS-Team activation resulted in a significant increase in the use of invasive monitoring that helped guide therapy.