Mechanical Circulatory Support in Cardiogenic Shock: Shock Team or Bust?

Cardiogenic shock (CS) accounts for 15% of all admissions to cardiac intensive care units, with acute myocardial infarction cardiogenic shock (AMICS) accounting for 30% of these. In contrast to other areas in cardiac care in which survival has continued to improve over the last two decades, CS still carries a mortality of around 40%. Temporary mechanical circulatory support (tMCS) therapies have shown inconsistent results in improving outcomes in CS, with the overall evidence not supporting its use, at least in unselected patients. Some of the main stumbling blocks leading to disappointing results of tMCS in CS are challenging patient identification and selection; delayed timing; lack of a systematic approach; inappropriate use of adjunct therapies and tools; lack of escalation/de-escalation and long-term planning; and disparities in regional/centre access to MCS. Among the most promising solutions to this challenge is the cardiogenic shock team (CST), which takes a standardized multidisciplinary approach to the acute management of CS. This paradigm brings expertise from advanced heart failure, interventional cardiology, cardiac surgery, cardiac intensive care, nursing, and others to address all of the aforementioned issues effectively. Unsurprisingly, hurdles to implementation exist, such as establishing effective team dynamics, maintenance of competence, and securing and maintaining adequate resources. However, although the shock-team approach is still in the early stages of clinical evolution, preliminary studies have been encouraging and suggest the value of broader application and evaluation.