‚Combat‛ Approach to Cardiogenic Shock

Abstract

The incidence of cardiogenic shock is rising, patient complexity is increasing and patient survival has plateaued. Mirroring organisational innovations of elite military units, our multidisciplinary medical specialists at the INOVA Heart and Vascular Institute aim to combine the adaptability, agility and cohesion of small teams across our large healthcare system. We advocate for widespread adoption of our 'combat' methodology focused on: increased disease awareness, early multidisciplinary shock team activation, group decision-making, rapid initiation of mechanical circulatory support (as appropriate), haemodynamic-guided management, strict protocol adherence, complete data capture and regular after action reviews, with a goal of ending preventable death from cardiogenic shock.

Flow Optimization, Management, and Prevention of LV Distention during VA-ECMO

“…and Kapur [42] has suggested a facilitating effect in withdrawal when the patients have an Impella in place to sustain left ventricular function. This knowledge, merged with the knowledge of the need of a short period of ECMO support and to the capability of Impella to interrupt the vicious cycle leading the patient to biventricular failure, may suggest the adoption of Impella when cardiac power output falls under 0.6 and IABP is judged not enough to maintain adequate end-organ perfusion [43], in this case ECMO need has to be evaluated.…”

Temporary support strategies for cardiogenic shock: extracorporeal membrane oxygenation, percutaneous ventricular assist devices and surgically placed extracorporeal ventricular assist devices

“…Recently, there was a call for a national initiative to develop a state level regionalized cardiogenic shock management system (20,21). One of the fundamental observations made from this initiative came from looking at the national trauma system, which has been successfully applied in the US with noted improvements in patient outcomes.…”

Cardiac shock care center — the next stage in the treatment of cardiogenic shock

“…Наличие мультидисциплинарной шоковой команды ("shock-team"), работающей в круглосуточном режиме и принимающей решения по тактике ведения пациента с КШ. В состав этой команды должны входить интервенционный хирург, сердечнососудистый хирург, врач анестезиолог-реаниматолог, врач кардиолог и специализированный средний медицинский персонал [21,22].…”

“…В США в клинике INOVA Fairfax Hospital в середине 2016г в рамках собственной шоковой инициативы (INOVA Cardiogenic Shock Initiative) также был разработан алгоритм ведения пациентов с КШ. Данный алгоритм практически полностью повторяет подход NCSI, основываясь на принципах ранней МПК, максимальной деэскалации лекарственной инотропной поддержки, активного применения инвазивного мониторинга гемодинамики и работы мультидисциплинарной шоковой команды [22]. Внедрение в 2017г у данного подхода в работу клиники позволило создать на его базе кардиологический шоковый центр нового образца.…”