(P117) SINGLE CENTRE COMPARISON OF PATIENTS MANAGED BY A CODE SHOCK TEAM VERSUS STANDARD OF CARE

Background: Multidisciplinary cardiogenic shock (CS) teams are associated with improved patient outcomes in CS. We established a CODE SHOCK program, comprising specialists from advanced heart failure, cardiac surgery, interventional cardiology, and critical care, and have previously demonstrated improved survival when compared to a historical CS patient cohort. The objective of this analysis was to examine clinical characteristics of a contemporary CS patient population, current practice patterns and to assess outcomes of patients managed under the CODE SHOCK algorithm compared to a parallel CS patient cohort.

METHODS AND RESULTS: A total of 156 patients were admitted in CS to the Cardiac Intensive Care Unit between June 2018 – December 2020. Forty-two patients were managed under the CODE SHOCK algorithm and 114 patients under standard clinical care (control). The predominant shock etiology was non-acute myocardial infarction shock (85%) and median left ventricular ejection fraction was 20% (IQR 15, 26). Patients managed under CODE SHOCK displayed greater severity of shock based on higher percentage of SCAI stage D/E CS and poor perfusion markers including higher peak lactate and acute liver injury (Table). A significantly higher proportion of patients managed under CODE SHOCK required multiple inotropes, mechanical ventilation, renal replacement therapy and utilization of temporary mechanical circulatory support (T-MCS) (Figure). Median duration of T-MCS was 6 days (IQR 3, 10) for CODE SHOCK vs. 3 days (IQR 1, 5) for control (p = 0.040). A higher proportion of CODE SHOCK patients were transitioned to durable advanced heart failure therapies: durable left ventricular assist device, 12 (29%) for CODE SHOCK vs. 2 (2%) for control (p < 0.001), and heart transplant, 2 (5%) for CODE SHOCK vs. 0 (0%) for control (p = 0.019). Median hospital length of stay was 15 days (IQR 8, 28) with no significant difference between study groups. There was no significant difference in short-term survival: 7-day survival, 76% for CODE SHOCK vs. 86% for control (p = 0.146), and survival to hospital discharge or durable advanced heart failure therapies, 71% for CODE SHOCK vs. 75% for control (p = 0.611).

Conclusion: Our CODE SHOCK algorithm identified high-risk CS patients and was associated with higher implementation of invasive hemodynamic monitoring and utilization of mechanical circulatory support. Despite greater severity of shock, CS patients managed under CODE SHOCK achieved similar improved short-term survival compared to standard care. Ongoing refinement of the CODE SHOCK approach is required to optimize patient selection and care to further improve outcomes in CS.