A heart attack is a life-threatening medical emergency, but about one in 10 heart attack victims experience a condition that can make a heart attack even more serious: cardiogenic shock. How serious? Without quick diagnosis and treatment, the survival rate of 30 days or to hospital discharge has been around 50%.
Although cardiogenic shock can be caused by other conditions, such as heart failure or end-stage cardiomyopathy, myocardial infarction—heart attack—is the most common cause, says Christopher Matchison, MD, an interventional cardiologist with Torrance Memorial. The most noticeable symptom is hypotension—low blood pressure—leading, ultimately, to an inability of the heart to adequately circulate blood.
However, while cardiogenic shock can seem like a worst-case scenario, there is some good news. “Early diagnosis can really change the course of a cardiogenic shock patient’s hospital stay and outcome,” says Dr. Matchison. To help ensure critical early diagnosis and treatment, he has spearheaded a cardiogenic shock program at Torrance Memorial.
“The program is essentially a protocol,” he explains. “It encourages early identification of cardiogenic shock in the emergency department by the ER physician, followed by activation of specialists including interventional cardiologists, cardiothoracic surgeons, critical care intensivists and other medical technicians. It makes rapid treatment of cardiogenic shock a collaborative effort.”
Once a patient is initially diagnosed as suffering from cardiogenic shock, he or she is moved to the hospital’s cardiac catheterization lab (cath lab) for more tests and monitoring. Getting the patient to the cath lab is important for a definitive diagnosis of cardiogenic shock versus other conditions because treatment is different in each case.
“In cardiogenic shock cases,” Dr. Matchison says, “there’s a dynamic, rapid deployment of our technology, and decisions to intensify or de-intensify treatment. Once out of the cath lab and into the ICU, there’s continued monitoring of patients. With cardiogenic shock patients, we check more factors, more often to help guide us in deciding what steps to take. Those checks are now done in a standardized way.”
Torrance Memorial’s treatment options include Impella—a small but powerful heart pump normally used to assist the heart for short periods, but for longer periods if needed—and ECMO (extracorporeal membrane oxygenation), an emergency life support machine that oxygenates and circulates blood, essentially replacing the patient’s heart and lungs when they are too weak or injured to function.
“The cardiogenic shock program leverages resources we already have,” Dr. Matchison notes. “It brings subspecialties together for rapid diagnosis and treatment. To carry the program forward, we’ve identified physician champions in different departments. They socialize the program’s protocols with others in their department.”
The outcome? Survival rates for cardiogenic shock have risen from 50% to 70%, Dr. Matchison says. “We see these cases once or twice a week, so it’s not a rare condition. Focusing on this type of cardiogenic shock and bringing all our subspecialties and capabilities together in a systematic way really makes a difference.”
