Cardiogenic Shock: A Silent Killer, But Here’s How AHN’s Shock Team Fights Back

Subbarao Elapavaluru, MD

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Cardiogenic shock remains a life-threatening challenge for the medical community, but Allegheny Health Network’s (AHN) specialized Shock Team at Allegheny General Hospital is improving patients’ chances for survival.

To boost survival rates in cardiogenic shock, AHN has implemented a multidisciplinary team-based protocol. Identified as the Shock Team, this group includes interventional and heart failure cardiologists, cardiovascular surgeons, and critical care physicians.

Once a patient is diagnosed with cardiogenic shock, the AHN Shock Team activates through a single-call line and assembles within minutes. Aligning with a patient’s needs and planned exit strategy, the team often decides to place a patient on temporary mechanical circulatory support. The temporary heart pump supports circulation for a brief time and aids in reversing metabolic abnormalities.

The Shock Team meets during daily rounds at AHN Allegheny General to assess their patients’ progress and recovery of heart function. They also consider permanent heart pumps or heart transplant if the heart does not recover.

Dr. Subbarao Elapavaluru, cardiothoracic intensivist and surgical director of AHN ECMO services, explained the primary goal is to quickly identify that a patient is in shock before it adversely affects other vital organs, such as the brain, liver, and kidneys.

“A patient can slip into shock within hours and even minutes, so the team’s expertise in recognizing shock is vital to a patient’s survival,” Dr. Elapavaluru said. “It’s also essential that we know when ECMO is the right treatment for a patient and when it’s too late, because we don’t want to needlessly prolong the patient’s and family’s suffering.”

A bridge to life

Shock occurs when the heart is so severely damaged that it can’t pump enough blood to meet the body’s needs. Without blood and fresh oxygen reaching the organs and brain, the body goes into a state of shock. It’s often caused by a severe heart attack, but it can also result from other heart issues.

Many patients need advanced monitoring and invasive treatments, such as mechanical heart pumps or extracorporeal membrane oxygenation (ECMO), to allow the heart and lungs to rest. Even with advanced care, about 50% of patients who suffer a myocardial infarction complicated by cardiogenic shock die, according to the American College of Cardiology.

“Temporary heart pumps and ECMO are powerful tools, but not magic bullets. They’re a bridge, a lifeline, which buy us time to address the underlying cause of a patient’s critical illness,” said Karthikeyan Ranganathan, MD, an interventional and heart failure cardiologist who leads the AHN Shock Team.

“That bridge needs to be built and maintained by a team of experts — surgeons, intensivists, cardiologists, nurses, respiratory therapists, pharmacists, rehabilitation teams, and more — all working together to provide the specialized care that these patients desperately need.”

Highest level of international recognition for ECMO excellence

The Extracorporeal Life Support Organization (ELSO) recently awarded AHN Allegheny General the Platinum Level Center of Excellence Award, joining just 13 other adult centers in the U.S. It indicates that AHN Allegheny General demonstrates an exceptional commitment to evidence-based processes and quality measures, staff training and continuing education, patient satisfaction, and ongoing clinical care.

This award adds to AHN Allegheny General’s rich history of ECMO care, previously recognized as a Gold Center of Excellence by the ELSO every year since 2015.

“We are honored to be the recipient of such a prestigious award for the advanced care provided to our patients,” said Tyler VanDyck, MD, cardiothoracic intensivist and medical director of AHN ECMO Services. “This accomplishment reflects the multidisciplinary team’s dedication to advancing health care that we continuously strive to achieve at AHN.”

Rapid, effective patient management

The multidisciplinary Shock Team at AHN Allegheny General are available 24/7 for consultation or evaluation of a patient with cardiogenic shock. They provide the full spectrum of ECMO care, including patients who require venovenous (VV) ECMO for lung support and venoarterial (VA) ECMO for those needing heart support.

Dr. Ranganathan explained that when a doctor refers a patient for cardiogenic shock, the AHN Shock Team immediately consults with bedside providers at other hospitals to determine a collaborative treatment plan.

“When a patient is too ill for transport to Allegheny General using conventional life support, our mobile team may consider placing the patient on ECMO prior to transfer,” Dr. Ranganathan said. “Then we can transfer the patient to AHN Allegheny General where the highly specialized care continues.”

To activate the cardiogenic Shock Team for patient care consultation or transfer, call the AHN Transfer Center at 1-888-660-4884. For more information on our clinical programs, email our cardiogenic shock and ECMO coordinator Debra Camp at debra.camp@ahn.org.