Team-Based Care in Cardiogenic Shock & PE — Summary

Why Teams Matter

Rising burden: Cardiogenic shock (CS) and pulmonary embolism (PE) have increasing incidence, diverse phenotypes/stages, high morbidity/mortality.
Drivers of poor outcomes: Delays in diagnosis/intervention, care variability, underuse of invasive monitoring and MCS.

Pharmacology, revascularization, temporary MCS (bridge to decision/destination), destination therapy(durable MCS/transplant), and advanced ICU management.

Isolated decision-making: Miscommunication, delayed therapy, suboptimal MCS selection → worse outcomes.
Team-based model: Multidisciplinary input “puzzle pieces” align → faster, coordinated, safer care.

Leadership & governance: Institutional backing; committees for protocols, education, registry/research.
Protocols: Activation, escalation, de-escalation with center-specific inclusion/exclusion criteria.
Registry: CS and PE databases for quality improvement and research.
Team members: ER, nursing, critical care, cardiology/interventional, CT surgery, hematology, others.

Aims: Early diagnosis, phenotype & SCAI staging, timely definitive therapy, recognize futility.
Workflow: Suspected CS → activate CST → fellow bedside assessment/data → team huddle → execute plan → follow-up (escalate/wean/palliate).
Activation (typical): Hemodynamic instability (e.g., SBP ≤90 and/or inotropes) plus end-organ hypoperfusion (e.g., lactate >2).
Decisions: Stabilize (pressors/inotropes), diagnostics (echo, cath, invasive hemodynamics), revascularization, temporary MCS (often VA-ECMO ± vent), longer-term pathways (durable MCS/transplant/palliation).
MCS selection factors: Failing chamber (LV/RV/bi-V) and oxygenation status guide device choice.
Network (“hub-and-spoke”): Retrieval, on-site cannulation, transfer; or managed locally per capability; palliative pathway when appropriate.

CST programs: Associated with faster intervention (shorter door-to-balloon/MCS times), greater use of PA catheters, optimized MCS selection, less overall MCS use, more appropriate VA-ECMO, and lower mortalityvs non-team models (multiple centers/systematic review).

Scope: Early diagnosis/management using standardized algorithms; collaboration across specialties.
Activation: High-risk PE (unstable) and intermediate-high risk PE (stable with RV strain).
Algorithms: Diagnosis (clinical scores, CTPA; echo if CTPA not feasible), treatment selection (anticoagulation, systemic thrombolysis, catheter-directed therapy, surgery, MCS), de-escalation, and clinic follow-up(anticoagulation plan, IVC filter decisions, RV recovery assessment).
Reported benefits: Reduced mortality/bleeding/LOS and increased appropriate use of advanced therapies.

Define purpose/objectives → appoint leadership → build team/committees → draft activation/escalation/weaning protocols & comms → simulation training → launch → audit/feedback → iterate protocols.