Department of Cardiovascular Anaesthesia and Critical Care, University Hospital of Bordeaux, Avenue du Haut Lévêque, 33604 Pessac, France.
University Bordeaux, INSERM, U1034 Biologie des maladies cardiovasculaires, 1 Av. Magellan, 33600 Pessac, France.
Eur Heart J Acute Cardiovasc Care. 2023 Dec 21;12(12):821-830. doi: 10.1093/ehjacc/zuad108.
Short-term mechanical circulatory support (STMCS) may be used as an intentional escalation strategy to treat refractory cardiogenic shock (rCS). However, with growing technical possibilities, making the right choice at the right time can be challenging. We established a shock team in January 2013 comprising a cardiac anaesthetist-intensivist, an interventional cardiologist, and a cardiac surgeon. Since then, a diagnosis of rCS has triggered a multidisciplinary team meeting based on a common algorithm. This study aimed to compare the decision-making process for STMCS for rCS before (2007-2013) and after (2013-2019) the creation of the shock team.
This before-and-after cohort study was conducted over a 156-month period. Post-cardiotomy rCS were excluded. The primary outcome was a 1-year survival rate. In total, 250 consecutive adult patients were included in the analysis (84 in the control group and 166 in the shock team group). At baseline, the CardShock score was not different between the two groups (5[3-5] vs. 5[4-6], P = 0.323). The 1-year survival rate was significantly higher in the shock team group compared with the control group (59% vs. 45%, P = 0.043). After a Cox regression analysis, the shock team intervention was independently associated with a significantly improved 1-year survival rate (HR: 0.592, 95% CI: 0.398-0.880, P = 0.010).
A multidisciplinary shock team-based decision for STMCS device implantation in rCS is associated with better 1-year survival rates.
短期机械循环支持（STMCS）可作为治疗难治性心源性休克（rCS）的一种有意升级策略。然而，随着技术可能性的不断增加，在正确的时间做出正确的选择可能具有挑战性。我们于 2013 年 1 月成立了一个休克团队，成员包括心脏麻醉师-重症监护医师、介入心脏病专家和心脏外科医生。自那时以来，rCS 的诊断会触发基于通用算法的多学科团队会议。本研究旨在比较创建休克团队前后（2007-2013 年和 2013-2019 年）用于 rCS 的 STMCS 的决策过程。
这是一项在 156 个月期间进行的前后队列研究。排除了心脏手术后 rCS。主要结局是 1 年生存率。共纳入 250 例连续成年患者进行分析（对照组 84 例，休克组 166 例）。基线时，两组的 CardShock 评分无差异（5[3-5] vs. 5[4-6]，P = 0.323）。休克组 1 年生存率明显高于对照组（59% vs. 45%，P = 0.043）。经过 Cox 回归分析，休克团队干预与显著改善的 1 年生存率独立相关（HR：0.592，95%CI：0.398-0.880，P = 0.010）。
基于多学科休克团队的决策进行 STMCS 设备植入治疗 rCS 与更好的 1 年生存率相关。
