Shock to Survival
A framework to improve the care and outcomes of people with
cardiogenic shock in the UK
October 2022
,Shock to Survival: a framework to improve the care and outcomes of people with cardiogenic shock in the UK
Endorsed by the following professional organisations:
Association for Cardiothoracic Anaesthesia & Critical Care
British Association of Critical Care Nurses
British Cardiovascular Society
British Cardiovascular Intervention Society
British Society of Echocardiography
British Society For Heart Failure
Intensive Care Society
Resuscitation Council (UK)
Royal College of Nursing
Society for Acute Medicine
Society for Cardiothoracic Surgery in Great Britain and Ireland
Scottish Intensive Care Society
The College of Paramedics
The Northern Ireland Intensive Care Society
Acknowledgements
We would like to thank the British Heart Foundation for their support
in the preparation of this document. We thank the Intensive Care
Society for hosting working groups during the development phase.
2
,Shock to Survival: a framework to improve the care and outcomes of people with cardiogenic shock in the UK
Contents
4 Foreword
6 Executive summary
9 Introduction
11 Steps to survival
13 Early recognition of cardiogenic shock (SC)
14 Early warning scores
16 Access to diagnostics
17 Right intervention, right patient, right time
18 The right patient: importance of early triage
20 The role of mechanical circulatory support (MCS)
21 The right specialists: CS-MDTs
23 Case study: a CS network in action
25 Network models of CS care
26 Building a CS network
28 CS Centres: leading and supporting a network
30 CS Centres: a team of teams
32 The role of Advanced Heart Failure Centres
33 Transferring patients across CS networks
34 Moving from ad hoc services to formative pathways
36 Data to drive change
38 Research to improve outcomes
39 References
42 Acronyms
43 Glossary
44 Members of UKCSWG Steering Group
3
, Shock to Survival: a framework to improve the care and outcomes of people with cardiogenic shock in the UK
Foreword
Every minute counts when it comes to managing patients presenting “Critical
with cardiogenic shock (CS). Recognition, assessment and treatment decisions
of the condition is set against a background of different healthcare must be
services and clinical pathways across all four nations of the UK. made
Critical decisions must be made quickly often with variable access to quickly
expertise in diagnosis and treatment. Not surprisingly, variation in often with
clinical practice leads to inconsistent clinical outcomes, unpredictable variable
healthcare costs and variable patient experience. This is a clinical access to
landscape that urgently needs re-mapping. expertise in
diagnosis
‘Shock to Survival’ makes several recommendations based on a and
considered scoping of current practice. It suggests the ideal pathway treatment”
for patients with CS bringing together best practice, the latest research,
standards based on evidence, and consensus recommendations
where gaps exist so that diagnostic delays are minimised and
treatment is expedited.
Central to the recommendations is a model of care based on clinical
networks and improvements in the processes for diagnosis, clinical
classification and referral for specialist management. The authors
recognise that every component of the system is vital. Access to
specialist expertise through clinical networks should help to attain
parity of access to high-quality care, while the continued training of all
healthcare staff is essential in identifying patients with CS.
The authors explore how this newly re-mapped landscape will
require re-design of current services and development of new services
and how processes will require re-engineering for patients to reap
the benefits. Credible leadership and collaborative working across
professional boundaries will be essential.
Importantly the authors put the patient at the centre of all decisions
about their care. In the dynamic environment of the acute care setting
against the backdrop of potential life-threatening situations, the clear
delivery of accurate information and the explanation of risks, benefits
and alternatives becomes even more crucial. ‘Shock to Survival’
recommends that patients are included as part of all decision-making
4
A framework to improve the care and outcomes of people with
cardiogenic shock in the UK
October 2022
,Shock to Survival: a framework to improve the care and outcomes of people with cardiogenic shock in the UK
Endorsed by the following professional organisations:
Association for Cardiothoracic Anaesthesia & Critical Care
British Association of Critical Care Nurses
British Cardiovascular Society
British Cardiovascular Intervention Society
British Society of Echocardiography
British Society For Heart Failure
Intensive Care Society
Resuscitation Council (UK)
Royal College of Nursing
Society for Acute Medicine
Society for Cardiothoracic Surgery in Great Britain and Ireland
Scottish Intensive Care Society
The College of Paramedics
The Northern Ireland Intensive Care Society
Acknowledgements
We would like to thank the British Heart Foundation for their support
in the preparation of this document. We thank the Intensive Care
Society for hosting working groups during the development phase.
2
,Shock to Survival: a framework to improve the care and outcomes of people with cardiogenic shock in the UK
Contents
4 Foreword
6 Executive summary
9 Introduction
11 Steps to survival
13 Early recognition of cardiogenic shock (SC)
14 Early warning scores
16 Access to diagnostics
17 Right intervention, right patient, right time
18 The right patient: importance of early triage
20 The role of mechanical circulatory support (MCS)
21 The right specialists: CS-MDTs
23 Case study: a CS network in action
25 Network models of CS care
26 Building a CS network
28 CS Centres: leading and supporting a network
30 CS Centres: a team of teams
32 The role of Advanced Heart Failure Centres
33 Transferring patients across CS networks
34 Moving from ad hoc services to formative pathways
36 Data to drive change
38 Research to improve outcomes
39 References
42 Acronyms
43 Glossary
44 Members of UKCSWG Steering Group
3
, Shock to Survival: a framework to improve the care and outcomes of people with cardiogenic shock in the UK
Foreword
Every minute counts when it comes to managing patients presenting “Critical
with cardiogenic shock (CS). Recognition, assessment and treatment decisions
of the condition is set against a background of different healthcare must be
services and clinical pathways across all four nations of the UK. made
Critical decisions must be made quickly often with variable access to quickly
expertise in diagnosis and treatment. Not surprisingly, variation in often with
clinical practice leads to inconsistent clinical outcomes, unpredictable variable
healthcare costs and variable patient experience. This is a clinical access to
landscape that urgently needs re-mapping. expertise in
diagnosis
‘Shock to Survival’ makes several recommendations based on a and
considered scoping of current practice. It suggests the ideal pathway treatment”
for patients with CS bringing together best practice, the latest research,
standards based on evidence, and consensus recommendations
where gaps exist so that diagnostic delays are minimised and
treatment is expedited.
Central to the recommendations is a model of care based on clinical
networks and improvements in the processes for diagnosis, clinical
classification and referral for specialist management. The authors
recognise that every component of the system is vital. Access to
specialist expertise through clinical networks should help to attain
parity of access to high-quality care, while the continued training of all
healthcare staff is essential in identifying patients with CS.
The authors explore how this newly re-mapped landscape will
require re-design of current services and development of new services
and how processes will require re-engineering for patients to reap
the benefits. Credible leadership and collaborative working across
professional boundaries will be essential.
Importantly the authors put the patient at the centre of all decisions
about their care. In the dynamic environment of the acute care setting
against the backdrop of potential life-threatening situations, the clear
delivery of accurate information and the explanation of risks, benefits
and alternatives becomes even more crucial. ‘Shock to Survival’
recommends that patients are included as part of all decision-making
4
