{
  "abstract": "Background Cardiogenic shock (CS) complicating acute myocardial infarction (AMI) carries high mortality. Early revascularisation improves survival, but the effect of structured multidisciplinary care on outcomes remains underexplored.Methods and results ACT-SHOCK is a service evaluation at a UK tertiary cardiac centre. Between May 2023 and May 2024, 82 patients with AMI-related CS requiring emergent percutaneous coronary intervention (PCI) were identified using protocolised physiological criteria and managed by an Advanced Cardiogenic-Shock Team (ACT). The ACT comprised interventional cardiologists, intensivists, anaesthetists, critical care staff and cardiac physiologists, coordinating PCI and ongoing care. Outcomes were compared with 83 historical controls from the year preceding ACT roll-out, who received standard care without ACT activation. Primary endpoints were 30-day and 1-year all-cause mortality; secondary outcomes included predictors of 30-day mortality.Within the ACT cohort, elevated lactate, critical care admission, invasive ventilation, out-of-hospital cardiac arrest and Society for Cardiovascular Angiography and Interventions (SCAI) Shock Stage E at first medical contact predicted 1-year mortality. Adjusted analyses showed ACT management was associated with lower 1-year mortality compared with standard care (HR 0.53, 95% CI 0.30 to 0.92; p=0.026). Although 30-day mortality was lower in the ACT group, this did not reach statistical significance (HR 0.71, 95% CI 0.39 to 1.29; p=0.26). Escalation from coronary care to critical care during the recovery phase occurred more promptly in the ACT group (9.7% vs 2.4%, p=0.09). At 24 hours, a smaller proportion of ACT patients remained in SCAI stages D/E compared with standard care (42% vs 48%; p=0.003).Conclusions Implementation of physiological criteria to identify CS and activation of a multidisciplinary ACT in a UK tertiary centre was associated with earlier detection and improved 1-year survival in AMI-related CS. These pilot data support further study across multiple UK centres to inform national policy and standardise care pathways.",
  "authors": [
    {
      "affiliations": [
        "Translation Health Sciences, University of Bristol, Bristol, UK",
        "Cardiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"
      ],
      "name": "Nitin Chandra Mohan"
    },
    {
      "affiliations": [
        "Intensive Care, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"
      ],
      "name": "Matt Govier"
    },
    {
      "affiliations": [
        "Translation Health Sciences, University of Bristol, Bristol, UK",
        "Cardiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"
      ],
      "name": "Thomas W Johnson"
    },
    {
      "affiliations": [
        "Cardiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"
      ],
      "name": "Ioannis Felekos"
    },
    {
      "affiliations": [
        "Cardiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"
      ],
      "name": "Gavin Richards"
    },
    {
      "affiliations": [
        "Cardiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"
      ],
      "name": "Julian Strange"
    },
    {
      "affiliations": [
        "Cardiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"
      ],
      "name": "Amardeep Dastidar"
    },
    {
      "affiliations": [
        "Cardiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"
      ],
      "name": "Novalia Sidik"
    },
    {
      "affiliations": [
        "Cardiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"
      ],
      "name": "Stephen Dorman"
    },
    {
      "affiliations": [
        "Cardiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"
      ],
      "name": "Nikhil Joshi"
    },
    {
      "affiliations": [
        "Intensive Care, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"
      ],
      "name": "Stefan Gurney"
    },
    {
      "affiliations": [
        "Intensive Care, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"
      ],
      "name": "Christopher Bourdeaux"
    },
    {
      "affiliations": [
        "Anaesthetics, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"
      ],
      "name": "Andrew Grant"
    },
    {
      "affiliations": [
        "Intensive Care, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"
      ],
      "name": "Kieran Oglesby"
    },
    {
      "affiliations": [
        "Cardiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"
      ],
      "name": "George McInerney-Baker"
    },
    {
      "affiliations": [
        "Cardiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"
      ],
      "name": "Sodiq Yaya"
    },
    {
      "affiliations": [
        "Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, UK",
        "School of Medicine and MTRC, Anglia Ruskin University Faculty of Medical Science, Chelmsford, UK"
      ],
      "name": "Thomas Keeble"
    },
    {
      "affiliations": [
        "Cardiology, King’s College Hospital NHS Foundation Trust, London, UK",
        "School of Cardiovascular and Metabolic Medicine & Sciences, King’s College London, London, UK"
      ],
      "name": "Nilesh Pareek"
    },
    {
      "affiliations": [
        "Cardiology, Barts Health NHS Trust, London, UK"
      ],
      "name": "Paul Rees"
    },
    {
      "affiliations": [
        "University of Southampton Faculty of Medicine, Southampton, UK",
        "Wessex Cardiothoracic Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK"
      ],
      "name": "Nick Curzen"
    },
    {
      "affiliations": [
        "Cardiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"
      ],
      "name": "Mark Mariathas"
    }
  ],
  "title": "Advanced Cardiogenic-shock Team versus standard care in cardiogenic SHOCK: a single centre service evaluation project",
  "uid": "5225491d-c2cd-5579-94ed-1e6aafcd0426"
}