CalShock: beyond the shock team, building on California's cardiogenic shock system of care.

Regional cardiogenic shock (CS) response systems are strong in concept but remain inconsistently implemented in the United States, with persistent heterogeneity in shock classification, mechanical circulatory support (MCS) deployment, hemodynamic monitoring, and transfer pathways. In California, these challenges are magnified by geography and fragmented hospital networks. The inaugural CALShock conference, convened in Los Angeles in February 2025 by the California Chapter of the American College of Cardiology, brought together multidisciplinary experts to synthesize emerging evidence and operational strategies for scalable improvements to shock systems of care. Key themes included routine use of shared classification and phenotyping frameworks, streamlined shock team activation and escalation workflows, transport as essential infrastructure, standardized prevention and management of MCS-related complications with clear exit strategies, broader registry participation, and integration of survivorship and post-discharge planning into comprehensive shock care. We describe the conference framework as a replicable model for other states and regions seeking to advance cardiogenic shock systems of care.