BACKGROUND
The management of cardiogenic shock (CS) remains challenging and is often associated
with a high mortality. In an effort to better manage CS, we implemented a multidisciplinary
“Shock Team” approach. As part of this effort, all patients admitted to the coronary
care unit (CCU) were screened for CS using the Society for Cardiovascular Angiography
and Interventions (SCAI) classification. The aim of the study was to 1) determine
the feasibility of CS screening, and, 2) characterize the incidence and severity of
CS in our CCU.
METHODS AND RESULTS
All patients admitted to the CCU at our centre over an 11-month period were included.
The SCAI classification was used to categorize patients into “at- risk” (stages A-B)
and “CS” groups (stages C- E). Screening for CS was to be performed on every patient
every 12hr while in CCU by the patient's nurse. Activation of the Shock Team was made
at the discretion of the CCU attending, and consisted of immediate communication between
the CCU attending, interventional cardiologist and cardiac surgeon on call. During
the initial 11-month period, 85% (1202/1419) of patients admitted to CCU were screened
according to the SCAI classifications. Screening failures were not uniform throughout
the study period, with a few months showing more screening failures (Figure 1). The
majority of patients screened were in the at- risk group (91.8%; A-B), while 8.2%
were in the CS group (C = 84 (7%), D = 7 (0.58%) and E = 11 (0.92%)). Patients in
the CS group were younger (66 ± 13 vs. 68 ± 12 years; p=0.047), experienced higher
in-hospital mortality (24% vs. 3.7%, p< 0.0001), and were more likely to be discharged
to another facility rather than home (65% vs 25%; p < 0.001), compared to at risk
patients.
CONCLUSION
Our study demonstrates that standardized screening for CS by nursing is feasible,
though ongoing education is required to minimize screening failures. Cardiogenic shock
is frequently diagnosed in patients admitted to our CCU and is associated with a high
mortality. Further study is required to determine if systematic SCAI classification
screening can facilitate early diagnosis of cardiogenic shock, shock team activation,
and improve outcomes in this patient population.
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© 2021 Published by Elsevier Inc.
