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Allegheny General Hospital Launches New “Shock Team” to Quickly, Effectively Treat Cardiogenic Shock

Monday, May 7, 2018

PITTSBURGH, Pa. — The “Shock Team” – Allegheny General Hospital’s (AGH) new immediate, multidisciplinary response approach – could be a lifesaver for patients suffering cardiogenic shock,  a devastating complication from acute myocardial infarction, the so-called “widow-maker” heart attack. AGH, part of Allegheny Health Network (AHN), recently established the team that includes interventional cardiologists, heart failure specialists, and cardiac surgeons. It is believed to be the first multidisciplinary team of its kind in the region focused on quickly and effectively treating cardiogenic shock.

For a patient in cardiogenic shock, the heart’s pumping ability is suddenly compromised and not enough blood and oxygen reach the brain and other organs. Almost 75 percent of shock cases occur after a massive heart attack, but shock also can happen after heart surgery, from cardiomyopathy, or to patients with chronic heart failure. Despite the many advances in cardiac care in recent years, roughly half of all patients who experience cardiogenic shock die in the hospital. 

“When we know that a patient is in shock, time is of the essence,” said Azam Hadi, MD, an AGH heart failure specialist who is leading the heart failure component of the hospital’s new cardiogenic shock team. “These patients need to be treated quickly, but it is crucial to make sure the best course of care is being taken in order to ensure the best chance of survival. Care coordination among different cardiac disciplines and the use of defined care pathways and algorithms to facilitate timely treatment decisions can improve clinical outcomes, and coronary revascularization should be considered whenever possible.”

The cardiogenic shock team’s response starts after a page, or the activation of the “shock beeper,” simultaneously informs physicians from three cardiac disciplines – heart failure, interventional cardiology, and cardiothoracic surgery – of the situation. 

“We are all looped in right off the bat,” said Mithun Chakravarthy, MD, who is leading the interventional cardiology component of the shock team. “Getting everyone on the team involved up front means we are able to quickly gain an understanding of the patient’s situation and then, as a team, recommend the best possible therapy for the patient.” 

Pulmonary artery catheterization is an invasive procedure that is an important diagnostic tool that can help physicians confirm cardiogenic shock and its severity. But for many patients, early mechanical circulatory support is needed to improve their chances of survival. In a five-month observational study last year at AGH, nearly 90 percent of patients treated for cardiogenic shock between June and December had a mechanical circulatory support device implanted, with the vast majority receiving an intra-aortic balloon pump (IABP). Others received percutaneous mechanical circulatory support or Extracorporeal Membrane Oxygenation (ECMO).

“Our data and other studies have shown that an early use of mechanical circulatory support can mean lower mortality rates,” said Masaki Tsukashita, MD, PhD, who is the lead cardiothoracic surgeon for the shock program. “What is most important initially is to stabilize the patient. Once that has happened, the shock team has more time to find the most appropriate long-term therapy for the patient.”

In its five-month observation period, 85 percent of patients treated for cardiogenic shock had been transferred to AGH from outside hospitals. The AGH shock team is now working with hospitals across Allegheny Health Network, as well as other hospitals in the region, in an effort to streamline care and review steps that should be taken before a patient is transported to AGH in order to ensure the best possible outcome.

“There remains a low level of awareness about cardiogenic shock,” said Srinivas Murali, MD, Director of AHN’s Cardiovascular Institute. “We are working to change that and stress to other providers how important it is to provide immediate care and get these patients to a regional center like AGH, where onsite monitoring and therapeutic technologies are available and the shock team can start coordinating care as soon as possible.” 

According to a recent scientific statement from the American Heart Association, a regional hub-and-spoke system of care delivered by multidisciplinary teams is recommended and necessary to effectively manage cardiogenic shock.

In addition to Dr. Hadi, Dr. Chakravarthy, and Dr. Tsukashita, other members of the shock team include program coordinator Shea McQuilkin plus the hospital’s interventional cardiologists, heart failure specialists, cardiothoracic surgeons, and critical care medicine specialists.