Saving More Lives with a Cardiogenic Shock Team
The calls to OHSU come from referring providers throughout the state and region who need help, and possible transfer, for patients with cardiogenic shock. Within minutes, the Shock Team assembles. Heart Failure and Transplant Team members, interventional cardiologists, surgeons, critical care intensivists and ECMO (respiratory and cardiac support) specialists talk with the referring doctor about the best way to care for their patient.
Cardiogenic shock is a life-threatening condition that happens when the heart can’t pump enough blood to meet the body’s needs. Causes include heart attacks, rhythm problems, infections, toxins, and structural issues.
With standard care, about 50% of people survive shock. OHSU’s shock team is at the forefront of a national push to save more lives. Initial studies suggest new approaches can push survival rates above 75%.
“It is a new way of thinking about shock,” Meyers says. “This is a wave of the future.”
Then came tiny heart pumps, like the Impella. The pump temporarily takes over for the heart’s left ventricle in a process called “unloading,” pushing blood and oxygen through the body and limiting damage.
When a patient arrives at the hospital with a heart attack, doctors know the importance of reducing the time between the first symptoms and unblocking the artery — often called “door to balloon time,” for the balloon used in angioplasties. Doctors are learning that a similar principle applies in cardiogenic shock, and that “door to unloading” is likely to become the measure of success in this setting, Meyers says.
Implanting a pump supports the heart right away, giving doctors more time to find and treat the cause of the shock. It also gives patients more time to recover before the next step in their care. If that step is surgery, being in stable condition gives them a better chance of surviving a stressful operation.
Some heart conditions, such as rhythm problems, can’t be fixed with angioplasty, Meyers says.
That’s where the shock team shows its value. The team includes specialists in interventional cardiology, heart surgery, heart failure, intensive care, and general cardiology.
“This is a team sport,” Meyers says. “We need everyone’s expertise, everyone’s buy-in, everyone’s thoughts, everyone’s point of view.”
OHSU’s heart surgery team is involved from the first call.
“It’s very important that we’re not simply technicians,” Tibayan says. “Rather, we are involved in the selection of the patients, the understanding of the patients, and what the potential strategies and pathways might be.”
A new addition to the shock team, Jeffrey Marbach, MBBS, MS, FRCPC, is working with Meyers to advance care in cardiogenic shock. Marbach is a cardiac intensivist and interventional cardiologist who came to OHSU in 2022 from Tufts Medical Center.
Under his guidance, OHSU is joining a national registry at Tufts to study new treatments for cardiogenic shock. The registry will give OHSU patients access to randomized trials and the latest research.