Thursday Night Live: How to Build a Cardiogenic Shock Team

In this Thursday Night Live video, Raymond Yau, M.D., FSCAI, and Robin Miller, DNP, MPH, ACNP, share their insights and experiences with building cardiogenic shock teams and programs.

Dr. Yau is an interventional cardiologist at the New Mexico Heart Hospital in Albuquerque, New Mexico and lead author of the paper “Blueprint for building and sustaining a cardiogenic shock program: Qualitative survey of 12 US programs” published in JSCAI in October 2024. Dr. Yau explains that trajectories of care for conditions such as trauma or myocardial infarction are typically well defined. “But in regards to cardiogenic shock, where do our patients go?” he asks. “It’s going to be quite variable. It’s going to depend on who’s on call, which hospital they go to. We really don’t have any systems of care that really address this need.”

Dr. Yau’s interest in shock programs was piqued by a paper by Papolos et al. published in JACC in 2021. The paper compared data from institutions with and without cardiogenic shock teams and highlighted increased use of pulmonary artery catheters, increased use of advance mechanical circulatory support devices, and a reduction in CICU mortality in the hospitals with cardiogenic shock teams. “I replicated very similar results,” Dr. Yau explains, describing how survival increased from 30.5% in 2021 before implementation of the cardiogenic shock program at his institution to 75.16% in the third years of the program.

Dr. Yau discussses why patients in cardiogenic shock have poor outcomes and how cardiogenic shock programs can address unmet needs. He identifies 7 steps for starting a shock program from his 2024 JSCAI paper, which provides insights from 12 institutions with diverse cardiogenic shock programs across the United States. These steps begin with measuring outcomes and finding champions and culminate with ensuring quality with a cardiogenic shock program coordinator.

Robin Miller, DNP, MPH, ACNP, an acute care nurse practitioner (ACNP) at St. Vincent Hospital in Portland, Oregon, describes the nuts and bolts of her role as a cardiogenic shock coordinator. “We facilitate communication. We are constantly working on protocol and practice. We are, as Dr. Yau said, a big part of the education.” She also explains the importance of reviewing data—shock team activation reviews, case reviews, and financial reviews—as well as evaluating protocol adherence, interdisciplinary collaboration, and quality improvement initiatives. She concludes with a case review highlighting how the shock team concept is implemented.