Kardiologia polska · 2025
First SHOCK TEAM in Poland: Single-hub-center experience with multidisciplinary care for cardiogenic shock.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Kuliczkowski Wiktor, Błaziak Mikołaj, Przybylski Roman, Goździk Waldemar, Zakliczyński Michał, Barteczko-Grajek Barbara, Kupiec Anna, Bochenek Maciej, Bielicki Grzegorz, Gajewski Piotr, Garus Mateusz, Sokolski Mateusz, Zymliński Robert, Zimoch Wojciech, Biegus Jan, Kosowski Michał, Protasiewicz Marcin, Kübler Piotr, Tomasiewicz Brunon, Sroka Michał, Balcer Bartosz, Wietrzyk Weronika, Dolata Natalia, Reczuch Krzysztof, Ponikowski Piotr
Аннотация
BACKGROUND: Cardiogenic shock (CS) remains a complex syndrome with alarmingly high mortality despite treatment advances.
AIMS: This study aimed to describe the experience of the management of patients with CS according to a standardized multidisciplinary team-based protocols.
MATERIAL AND METHODS: This is a retrospective analysis of patients with a diagnosis of CS admitted to a large academic tertiary hospital between 2021 and 2023. Patients were managed according to the CS protocols developed at our institution by a dedicated multidisciplinary shock team. We report patients' clinical characteristics, mechanical circulatory support (MCS) utilization, and in-hospital outcomes.
RESULTS: Over the three-year period, we identified 257 patients (median age: 69 years, 69% males). In this cohort, acute coronary syndrome was the most common cause of CS (55% of patients), 17% presented with out-of-hospital cardiac arrest, 18% experienced in-hospital cardiac arrest, and 20% of patients were transferred from remote centers. An MCS system was used in 39% of all patients. In-hospital mortality was 62% with significant improvement in consecutive 1-year periods: 75% in 2021 vs. 69% in 2022 vs. 44% in 2023, respectively, P = 0.004 for trend. This improvement was particularly evident in the group supported with MCS: all-cause mortality: 75% in 2021, 50% in 2022, and 29% in 2023 (P = 0.005). The use of MCS was a significant independent predictor of improved survival in 2022 and 2023 (odds ratio, 0.38; confidence interval, 0.149-0.996; P = 0.04).
CONCLUSIONS: Our results suggest that a standardized multidisciplinary approach incorporating the availability of MCS therapies and heart transplantation may be associated with improved outcomes in patients with CS.
AIMS: This study aimed to describe the experience of the management of patients with CS according to a standardized multidisciplinary team-based protocols.
MATERIAL AND METHODS: This is a retrospective analysis of patients with a diagnosis of CS admitted to a large academic tertiary hospital between 2021 and 2023. Patients were managed according to the CS protocols developed at our institution by a dedicated multidisciplinary shock team. We report patients' clinical characteristics, mechanical circulatory support (MCS) utilization, and in-hospital outcomes.
RESULTS: Over the three-year period, we identified 257 patients (median age: 69 years, 69% males). In this cohort, acute coronary syndrome was the most common cause of CS (55% of patients), 17% presented with out-of-hospital cardiac arrest, 18% experienced in-hospital cardiac arrest, and 20% of patients were transferred from remote centers. An MCS system was used in 39% of all patients. In-hospital mortality was 62% with significant improvement in consecutive 1-year periods: 75% in 2021 vs. 69% in 2022 vs. 44% in 2023, respectively, P = 0.004 for trend. This improvement was particularly evident in the group supported with MCS: all-cause mortality: 75% in 2021, 50% in 2022, and 29% in 2023 (P = 0.005). The use of MCS was a significant independent predictor of improved survival in 2022 and 2023 (odds ratio, 0.38; confidence interval, 0.149-0.996; P = 0.04).
CONCLUSIONS: Our results suggest that a standardized multidisciplinary approach incorporating the availability of MCS therapies and heart transplantation may be associated with improved outcomes in patients with CS.