Increasing Options for Life-Saving Care: Focus on Multidisciplinary Cardiogenic Shock Team at UH

Record number of heart and lung transplants performed at University Hospitals in 2019

Innovations in Cardiovascular Medicine & Surgery | Winter 2020

Coordinated, multidisciplinary cardiogenic shock teams lead to better cardiovascular outcomes, often saving lives that otherwise would have been lost. A report published in the Journal of the American College of Cardiology just last year, for example, found that a standardized, team-based approach to these cases improved 30-day survival from 47 percent in 2016 to 58 percent in 2017 and 77 percent in 2018. 

An early adopter of this concept, UH Harrington Heart & Vascular Institute has had a multidisciplinary Shock Team in place across the large UH health system since 2017. In 2018, UH physicians initiated ECMO (extracorporeal membrane oxygenation) to stabilize acute shock 52 times and achieved a mortality index of .99 — one of the lowest among U.S. News and World Report top-ranked heart centers.

Eiran Gorodeski, MD, MPH, new Director of the Advanced Heart Failure Center at UH, and Associate Professor of Medicine, Case Western Reserve University School of Medicine, is gratified with the improved outcomes that have been achieved and is committed to help the team further advance care and survival of our patients.

“I think we have a novel offering here based on what’s going on across the United States” he says. “Very few hospital systems have a system-integrated approach to shock, and we have been doing this for a while. I think we have tremendous success in rapidly identifying which resources patients need and delivering care to them quickly, and getting them to the right place at the right time. For us, every second counts. We established a well-coordinated and agile team with extraordinary skills, expertise and necessary technologies to attend patients with shock, a deadly super-acute syndrome. Some patients need care in place – others need to be rapidly transported because they may now require more advanced mechanical support and intensive care treatment.”

How does the Shock Team operate? When a patient presents with cardiogenic shock at a UH facility, the event immediately triggers a rapid response.

The UH Shock Team includes physicians specializing in emergency medicine, critical care, interventional cardiology, heart failure and cardiovascular surgery, as well as expert physician assistants, nurse practitioners, nurses and respiratory therapists. On-call team members are activated through a single phone call via the UH phone transfer center and immediately convene by phone to decide the optimal front-line approach to stabilize each patient. Using a detailed algorithm that the team has developed, they evaluate the severity of shock and coordinate efforts to determine a treatment plan.

UH Harrington Heart & Vascular Institute offers 15 locations throughout Northeast Ohio that can provide front-line therapy and activate the Shock Team. Seven of these facilities also offer full heart catheterization capabilities and percutaneous mechanical heart support technologies that generates a full hemodynamic profile to inform treatment decisions. If escalation of care or a greater level of mechanical support is indicated, patients are quickly transferred within the UH system to the most suitable setting.

“Community integration is central to our success,” says Marco A. Costa, MD, PhD, MBA, President of UH Harrington Heart & Vascular Institute. “It is our differentiator and is an integral part of our vision and mission."

“We’ve conducted outreach both within the system and to cardiac programs outside of UH,” adds Michael Zacharias, DO, Medical Director of Mechanical Circulatory Support, UH Harrington Heart & Vascular Institute, and Assistant Professor of Medicine, School of Medicine. “By informing referring physicians of the system-integrated approach to care across NE Ohio and quaternary capabilities available at UH Cleveland Medical Center, we are saving lives that may not have been saved before."

According to Francis (Ted) Lytle, MD, Medical Director, Intensive Care Center, UH Harrington Heart & Vascular Institute at UH Cleveland Medical Center, “The cardiogenic shock program emphasizes the collaboration of ‘the team,’ and patients and their families are active members of the team, too. Our shock team includes experts in surgery, cardiology, intensive care and anesthesia. We’ve treated thousands of patients with cardiogenic shock, achieving one of the highest survival rates in the country. One of the reasons of our success is timeliness.  We created an integrated network and deployed life-saving technologies across UH hospitals to enable immediate response, 24/7, to the needs of our patients with cardiogenic shock anywhere in our health system.” 

Already, the Shock Team is serving as a great safety net, giving more patients the possibility of receiving subsequent life-saving care.
“All of this is in the same pipeline – you can’t think of the cardiogenic Shock Team as free-standing,” Dr. Gorodeski says. “Some patients will go on to recover and not need anything additional, which of course is our ultimate goal. But other patients have severe ongoing cardiac disease, and we can offer them the whole range of treatments, including TAVR, LVAD and heart transplantation. I can tell you that last year in 2019, combined volume of thoracic organ transplants at highest level in UH history. I think that really demonstrates the power of the healthcare system in taking care of patients’ comprehensive needs. The Shock Team is a big part of that success.”

Looking ahead, UH is committed to serving as a national leader to educate cardiogenic shock care providers. Thanks to a recent generous $5 million gift from Angela and James Hambrick, UH has established a new Center of Excellence — the Hambrick Center for Cardiac Recovery at UH Harrington Heart & Vascular Institute. In the rapidly evolving healthcare environment, the Hambrick Center will enable UH physicians to remain at the forefront of the most advanced treatment and integrated processes to improve survival rates for patients throughout Northeast Ohio and across the country.

For more information about the cardiogenic Shock Team at UH, please call 216-553-1439.