The Intensive Care Society and British Cardiovascular Society publish ‘Shock to Survival: A framework to improve the care and outcomes of people with cardiogenic shock in the UK’.
Nearly 1 in 10 patients suffering from a heart attack will develop cardiogenic shock, and up to half of those patients will not survive to hospital discharge.
Cardiogenic shock occurs when a problem with the heart means it can no longer supply adequate blood and oxygen to vital organs. This causes a life-threatening state known as hypoperfusion that can rapidly lead to multi-organ failure and death. A myocardial infarction [heart attack] is the most common cause. However, other problems such as inflammation of the heart muscle (myocarditis), side effects of drugs, childbirth complications, or deterioration of existing heart diseases including heart failure can also result in cardiogenic shock.
This is a clinical landscape that urgently needs re-mapping to ensure patients receive adequate and safe care. This framework provides a consistent approach by combining pathways from acute cardiac and critical care, supported by evidence and guidance which can be easily adopted by all UK hospitals.
Data is limited in cardiogenic shock patient outcomes due to inconsistencies as a result of service provision variations across all areas of the UK.
‘Shock to Survival’ makes several recommendations based on a considered scoping of current practice. It suggests the ideal pathway for patients with cardiogenic shock bringing together best practice, the latest research, standards based on evidence, and consensus recommendations where gaps exist so that diagnostic delays are minimised and treatment is expedited:
- Increase awareness among healthcare staff that any deteriorating patient with an elevated NEWS-2 score and evidence of hypoperfusion should prompt consideration of cardiogenic shock as a potential cause. Echocardiography (or focused cardiac ultrasound [focus]) and electrocardiogram should follow urgently
- Improve access to echocardiography out-of-hours (including focus with expert review), to support/exclude the diagnosis of cardiogenic shock or other cardiac pathologies
- Adopt Society for Cardiovascular Angiography and Interventions staging as the standardised descriptor of cardiogenic shock to facilitate triage, communication and expediency of discussion with a cardiogenic shock centre
- Establish cardiogenic shock centres as part of regional cardiogenic shock networks to bring together the most critically ill patients with the right clinical expertise
- Ensure equity of access to cardiogenic shock expertise and care, including short-term Mechanical Circulatory support, through the design of cardiogenic shock networks and distribution of cardiogenic shock centres
- Develop clear pathways of care and protocols for cardiogenic shock care within networks to complement existing acute cardiac care pathways, including 24/7 access to cardiogenic shock-multi professional teams and transfer to cardiogenic shock centres
- Develop network protocols for patient selection for short-term Mechanical Circulatory Support
Define a minimum cardiogenic shock dataset, and collect this data, including through existing national audits, encompassing the entire patient pathway - Prioritise high-quality research in cardiogenic shock to address important areas of uncertainty, including patient selection for short-term Mechanical Circulatory Support and cost-effectiveness of improved care pathways
We recommend ‘Shock to Survival’ to all clinicians who care for patients with cardiogenic shock as well as policy makers and those who commission services across the UK. The recommendations set out a roadmap to enable improvements to be made which could ultimately save lives.
