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实施休克治疗团队治疗心源性休克后的临床结局:一项系统评价

Clinical outcomes following shock team implementation for cardiogenic shock: a systematic review.

作者信息

Abdelnabi Mohamed, Elsaeidy Ahmed Saad, Aboutaleb Aya Moustafa, Johanis Amit, Ghanem Ahmed K, Rezq Hazem, Abdelazeem Basel

机构信息

Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, Stanford, California, 94305, USA.

Faculty of Medicine, Benha University, Benha, Egypt.

出版信息

Egypt Heart J. 2024 Dec 30;76(1):163. doi: 10.1186/s43044-024-00594-z.

Abstract

BACKGROUND

Cardiogenic shock is a critical cardiac condition characterized by low cardiac output leading to end-organ hypoperfusion and associated with high in-hospital mortality rates. It can manifest following acute myocardial infarction or acute exacerbation of chronic heart failure. Despite advancements, mortality rates remain elevated, prompting interest in multidisciplinary approaches to improve outcomes. This manuscript presents a review focused on the concept of a cardiogenic shock team and its potential impact on patient management and outcomes.

METHODS

A comprehensive search was performed on March 19, 2023, covering PubMed, Web of Science, Scopus, Embase, and Cochrane Library. We included primary studies (prospective and retrospective) only and evaluated their quality using the Newcastle-Ottawa Quality Scale. This review was registered in PROSPERO (CRD42023440354).

RESULTS

Six relevant studies with 2066 cardiogenic shock patients were included, of which 1071 were managed by shock teams and 995 received standard care. Findings from the reviewed studies indicated the favorable outcomes associated with implementing cardiogenic shock teams. Patients managed by these teams exhibited higher 30-day and in-hospital survival rates compared to those without team intervention. The implementation of cardiogenic shock teams was linked to reduced in-hospital and intensive care unit mortality rates. Additionally, shock team involvement was associated with shorter door-to-balloon times.

CONCLUSION

The findings suggest that cardiogenic shock teams play a crucial role in improving patient outcomes through earlier detection and timely interventions. Despite challenges in team implementation, their potential to reduce mortality and improve efficiency in patient care warrants further research and greater integration of multidisciplinary strategies into clinical practice.

摘要

背景

心源性休克是一种严重的心脏疾病,其特征是心输出量低,导致终末器官灌注不足,并伴有较高的住院死亡率。它可在急性心肌梗死或慢性心力衰竭急性加重后出现。尽管取得了进展,但死亡率仍然居高不下,这促使人们对多学科方法改善治疗结果产生兴趣。本文献综述聚焦于心源性休克团队的概念及其对患者管理和治疗结果的潜在影响。

方法

于2023年3月19日进行了全面检索,涵盖了PubMed、科学网、Scopus、Embase和考克兰图书馆。我们仅纳入了原始研究(前瞻性和回顾性),并使用纽卡斯尔-渥太华质量量表评估其质量。本综述已在国际前瞻性系统评价注册库(CRD42023440354)登记。

结果

纳入了六项涉及2066例心源性休克患者的相关研究,其中1071例由休克团队管理,995例接受标准治疗。综述研究的结果表明,实施心源性休克团队可带来良好的治疗结果。与未接受团队干预的患者相比,由这些团队管理的患者30天和住院生存率更高。心源性休克团队的实施与降低住院和重症监护病房死亡率相关。此外,休克团队的参与与缩短门球时间有关。

结论

研究结果表明,心源性休克团队通过早期检测和及时干预在改善患者治疗结果方面发挥着关键作用。尽管团队实施存在挑战,但其降低死亡率和提高患者护理效率的潜力值得进一步研究,并将多学科策略更广泛地整合到临床实践中。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0019/11685370/ec47198b61a1/43044_2024_594_Fig1_HTML.jpg

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