Brusca Samuel B, Caughron Hope, Njoroge Joyce N, Cheng Richard, O'Brien Connor G, Barnett Christopher F
Division of Cardiology, Department of Internal Medicine, University of California, San Francisco, California, USA.
Curr Opin Cardiol. 2022 May 1;37(3):241-249. doi: 10.1097/HCO.0000000000000967.
Cardiogenic shock (CS) is a highly morbid condition with mortality remaining greater than 30% despite improved pathophysiologic understanding and access to mechanical circulatory support (MCS). In response, shock teams modeled on successful multidisciplinary care structures for other diseases are being implemented nationwide.
Primary data supporting a benefit of shock team implementation on patient outcomes are relatively limited and entirely observational. Four single-center before-and-after studies and one multicenter registry study have demonstrated improved outcomes in patients with CS, potentially driven by increased pulmonary artery catheter (PAC) utilization and earlier (and more appropriate) initiation of MCS. Shock teams are also supported by a growing body of literature recognizing the independent benefit of the interventions they seek to implement, including patient phenotyping with PAC use and an algorithmic approach to CS care. Though debated, MCS is also highly likely to improve CS outcomes when applied appropriately, which further supports a multidisciplinary shock team approach to patient and device selection.
Shock teams likely improve patient outcomes by facilitating early patient phenotyping and appropriate intervention. Institutions should strongly consider adopting a multidisciplinary shock team approach to CS care, though additional data supporting these interventions are needed.
心源性休克（CS）是一种高发病症，尽管对其病理生理学的理解有所改善，且可获得机械循环支持（MCS），但其死亡率仍超过30%。作为应对措施，以其他疾病成功的多学科护理结构为蓝本的休克治疗团队正在全国范围内实施。
支持实施休克治疗团队对患者预后有益的主要数据相对有限，且完全是观察性的。四项单中心前后对照研究和一项多中心注册研究表明，CS患者的预后有所改善，这可能是由于肺动脉导管（PAC）使用增加以及更早（且更合适）启动MCS所致。越来越多的文献也支持休克治疗团队，这些文献认识到他们试图实施的干预措施具有独立益处，包括使用PAC进行患者表型分析以及采用算法方法进行CS护理。尽管存在争议，但MCS在适当应用时也极有可能改善CS的预后，这进一步支持了采用多学科休克治疗团队方法来选择患者和设备。
休克治疗团队可能通过促进早期患者表型分析和适当干预来改善患者预后。各机构应强烈考虑采用多学科休克治疗团队方法来治疗CS，不过仍需要更多支持这些干预措施的数据。
