心源性休克团队协作的必要性——促进基于团队的护理模式,以改善预后并确定最佳实践。

Need for a Cardiogenic Shock Team Collaborative-Promoting a Team-Based Model of Care to Improve Outcomes and Identify Best Practices.

机构信息

Division of Cardiology Duke University Durham NC USA.

Department of Cardiovascular Medicine Mayo Clinic Rochester MN USA.

出版信息

J Am Heart Assoc. 2024 Mar 19;13(6):e031979. doi: 10.1161/JAHA.123.031979. Epub 2024 Mar 8.

Abstract

Cardiogenic shock continues to carry a high mortality rate despite contemporary care, with no breakthrough therapies shown to improve survival over the past few decades. It is a time-sensitive condition that commonly results in cardiovascular complications and multisystem organ failure, necessitating multidisciplinary expertise. Managing patients with cardiogenic shock remains challenging even in well-resourced settings, and an important subgroup of patients may require cardiac replacement therapy. As a result, the idea of leveraging the collective cognitive and procedural proficiencies of multiple providers in a collaborative, team-based approach to care (the "shock team") has been advocated by professional societies and implemented at select high-volume clinical centers. A slowly maturing evidence base has suggested that cardiogenic shock teams may improve patient outcomes. Although several registries exist that are beginning to inform care, particularly around therapeutic strategies of pharmacologic and mechanical circulatory support, none of these are currently focused on the shock team approach, multispecialty partnership, education, or process improvement. We propose the creation of a Cardiogenic Shock Team Collaborative-akin to the successful Pulmonary Embolism Response Team Consortium-with a goal to promote sharing of care protocols, education of stakeholders, and discovery of how process and performance may influence patient outcomes, quality, resource consumption, and costs of care.

摘要

尽管采用了当代治疗方法,心源性休克的死亡率仍然很高,在过去几十年中,没有任何突破性的治疗方法显示可以提高生存率。心源性休克是一种时间敏感的病症,通常会导致心血管并发症和多器官衰竭,需要多学科专业知识。即使在资源充足的环境中,管理心源性休克患者仍然具有挑战性,而且一个重要的亚组患者可能需要心脏替代治疗。因此,专业协会提倡利用多个提供者的集体认知和程序专业知识,以协作、团队为基础的方法进行护理(“休克团队”),并在一些高容量临床中心实施。一个逐渐成熟的证据基础表明,心源性休克团队可能会改善患者的预后。尽管存在几个开始为护理提供信息的登记处,特别是在药物和机械循环支持的治疗策略方面,但这些登记处目前都没有专注于休克团队方法、多专业合作、教育或流程改进。我们建议创建一个心源性休克团队协作组织-类似于成功的肺栓塞反应团队联盟-旨在促进护理协议的共享、利益相关者的教育,以及发现流程和绩效如何影响患者的预后、质量、资源消耗和护理成本。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f8ab/11009990/51ff056d027f/JAH3-13-e031979-g002.jpg

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