European Heart Journal Supplements: Tharusan Thevathasan Shares Insights on the Heart Team Approach to Cardiac Arrest

Key Takeaways:

• Understanding Post-Cardiotomy Cardiogenic Shock (PCCS) Scenarios: PCCS commonly arises due to the inability to wean from cardiopulmonary bypass (CPB) or refractory low cardiac output syndrome (LCOS) after surgery, requiring rapid assessment and intervention.
• Tools for Early Recognition: Early recognition of post-cardiotomy cardiogenic shock relies on tools such as echocardiography, pulmonary artery catheter (Swan-Ganz), and lactate measurements to assess and monitor the patient's condition.
• Escalation to Mechanical Circulatory Support (MCS) devices: Escalation to Impella CP^®, Impella 5.5^® heart pump, or VA ECMO, based on ventricular needs, improves outcomes, especially with early intervention in cases of uncertain myocardial recovery.
• Critical Approach: Early recognition, fast action, patient-specific support, and consultative teamwork are pivotal for improving patient survival in post-cardiotomy cardiogenic shock.

Tharusan Thevathasan, MD, discusses his paper, “The heart team approach to cardiac arrest,” published in the 2025 European Heart Journal supplement titled “Mechanical Circulatory Support in Special Settings: the Heart Team Approach.” Dr. Thevathasan is a cardiologist at Deutsches Herzzentrum der Charité, in Berlin, Germany.

Dr. Thevasthasan briefly explains the difference between in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA). He describes IHCA as “a fire in a controlled environment where immediate resources, medical history, and monitoring are usually at hand for smooth action,” while OHCA “strikes in the wild, outside of the hospital’s safety net, requiring a race against time to transport the patient to a specialized center.” He emphasizes that this difference is crucial “because it dictates how quickly, and how effectively interventions can be made, shaping the paths toward survival and recovery.”

Dr. Thevasthasan highlights the importance of distinguishing between refractory cardiac arrest and post-resucitation shock, both of which may require temporary mechanical circulatory support (MCS). He discusses the importance of unloading the left ventricle, especially in patients receiving VA ECMO, likening unloading to “easing the burden on an overloaded engine, reducing strain, and improving coronary perfusion, potentially leading to better outcomes.”

Mortality remains high despite advances in management of cardiac arrest, primarily due to severe organ failure and neurological damage. Dr. Thevasthasan briefly discusses the role of organ donation after circulatory death (DCD) and organ donation after brain death (DBD).

“The heart team is the cornerstone of cardiac arrest management. Like an orchestra, the cardiologists, intensivists, cardiac surgeons, and emergency specialists play in harmony. This multidisciplinary ensemble ensures that each patient receives a tailored and timely treatment plan, whether it’s choosing the right temporary MCS, or guiding organ donation decisions. The synchronized efforts form the backbone of comprehensive care, potentially improving the chances of survival and neurological recovery. A well-coordinated heart team acts like a finely tuned engine optimizing care pathways, and driving the patient’s journey toward recovery, making an important difference in how well they recover after the storm of cardiac arrest.”