David A. Baran, M.D., highlights a classification system for cardiogenic shock in this video. This expert consensus statement on the classifications was endorsed by the American College of Cardiology (ACC) the American Heart Association (AHA), the Society of Critical Care Medicine (SCCM), and the Society of Thoracic Surgeons (STS).
Hi, I'm dr David Baron, I'm the system director for advanced heart failure, transplant mechanical support here at some Towers Heart Hospital. And I've been interested in cardiogenic shock and the concept of shock teams for quite a number of years. When I joined in 2017, 1 of the initial visions was to bring a shock team to Sentara with the recognition that team based care really results in better outcomes concurrently. It was working with some of the large groups and societies to really try and standardize the way that you talk about cardiogenic shock And it hadn't actually advanced from just sort of discussions at meetings till late 2018 when a whole group of us got together and said, you know, does the new york heart association class for heart failure? What is there for shock? And fast forward to the middle of 2019, we publish our first expert consensus guidelines and really laid forth a vision from shock from stages A to E A being at risk B being beginning shock, see being classic cardiogenic shock. D being deterioration. Andy being extremists, the sickest of the sick. And we phrased it actually is a pyramid. And interestingly that we put out, we want to see if there was any uptake. And the uptake. Asher was enormous because it was such a real need. Think of it this way, if you doctor calls you have a patient it's really critical to understand exactly what are you getting? Can you help them? Are they appropriate for therapy And with heart failure we have a lot of good descriptors, both cardiogenic shock. We had none. So it was very common that you would get a patient that somebody was quite concerned was in severe cardiogenic shock and might come and you have the surgeon there with you waiting at the bedside and in fact it was relatively modest trouble. And other times where they said oh this guy is just a little bit sick but you know it's friday, why don't we send them over and patient would come over and be so critically ill. And you really be somewhat unprepared. Now with the sky shock classification we can actually talk in a common language And it doesn't require calculator, doesn't require labs, doesn't require catheter, it takes the information you have available to you and integrates the patient from stage to stage G. Uh and that has really made a big difference. There's been almost 20 publications since that time looking at the impact of this validating it showing that it actually predicts survival very clearly. If your sky stage goes from B to C. To D. D. Even e. Your survival is directly predicated on that. Its interaction with age and also with the cardiac arrest. But it's been really rewarding to help lead the team doing that And very exciting that this all came out of Sentara along with the other co writers and the paper based on that we decided that we would as soon as we had finalized this classification we started using in our own shock team. And since we have a database and a great shock coordinator coordinates all of this we decided to go ahead and publish a result. We actually found interestingly that prospectively assigning sky stage actually could predict what the outcomes were of the patients. About 166 patients and about a year and a half of the shock team. And the top line results of that paper showed that actually not only you could predict the outcome of the patient based on their sky stage, it didn't matter whether they got a bloom pump or an a paella or whatever other device. The only important factors were aged in the sky stage at the beginning as well. Because these were all collected prospectively, we would routinely record the next day what was happening with the patient, What was their follow up sky stage. And in that paper were able to show that if in fact your sky stage improves, your outcome was completely different and much, much better than if it stayed the same or it started to get worse. We published this this year in uh cardiac catheterization intervention. And it's gotten a lot of interest because it allows you in the outlying hospital and say, well, If I can't send every patient and goodness knows, we don't always have a bed for every patient. But if the patient's stable are getting better, actually, the outcome is quite good. The survival, even in cardiogenic shock is upwards of 80%. But in fact if the patient's lingering, they're not getting better or getting worse in their sky stage, that patient has a very, very abysmal trajectory, very likely to die. And it allows you at the bedside to be able to say, well, is this something we can fix? What we call for a consult or is this a case where we need to move on to palliative interventions? Because this is not a battle we're gonna win. I think that's really the tremendous utility of the sky stage. We couldn't have known when we designed it. But interestingly, what's very simple actually does work. If you're getting better, you'll probably be ok if you're getting worse, you need to re evaluate and say, is this fixable if the titanic is heading towards the iceberg and you knew to shift gears and turn the right moment, might have avoided catastrophe. As somebody that's been so interested in cardiogenic shock, it's so nice to people have some very practical advice to all the referring physicians. And in fact, this paper has garnered international attention for me very privileged to lead the shock team with my colleagues and intervention, pulmonary critical care. I see a nursing, all of the other disciplines and together, I think we are really making a difference is since Sarah
