Researchers identified eight indicators of cardiogenic shock to help emergency responders and health care teams initiate early care interventions.
A new early warning system could make significant headway in the prevention of cardiogenic shock, a heart condition with an approximate 50 per cent chance of survival. A study led by Vancouver Coastal Health Research Institute researcher Dr. Christopher Fordyce introduced the EARLY SHOCK risk scoring algorithm, a novel approach to detect the signs and symptoms of cardiogenic shock.
Cardiogenic shock is an emergency situation characterized by the heart’s inability to pump sufficient blood throughout the body to maintain vital functionality. It often occurs following a severe heart attack, particularly an ST-elevation myocardial infarction (STEMI) heart attack from a complete blockage of a coronary artery — although heart attack is not necessary for cardiogenic shock to occur.
“Time is of the essence when someone experiences cardiogenic shock,” shares Fordyce. “An accurate, timely diagnosis significantly enhances the ability of health care teams to amass the right specialists and initiate the appropriate treatment interventions.”
“The faster the condition is diagnosed and treated, the greater the odds of saving the patient and the better the long-term health outcomes.”
Presently, cardiogenic shock can be masked by symptoms associated with other heart conditions, making a rapid diagnosis challenging. The EARLY SHOCK score created by Fordyce and his team removes the guesswork with a standardized approach to assess the signs and symptoms of cardiogenic shock.
Rapid cardiogenic shock triaging helps make every minute count
Researchers analyzed the hospital records of 2,736 STEMI patients admitted to a Vancouver Coastal Health facility between April 1, 2012 and December 31, 2020. To be included in the study, STEMI patients had to have been treated with conventional primary percutaneous coronary intervention (PCI) to pump blood through their bodies.
While most STEMI patients did not develop cardiogenic shock, 451 did, representing 15 per cent of individuals included in the analysis. Researchers scanned these patient records for patterns, with the EARLY SHOCK score comprising eight clear-cut independent clinical predictors of cardiogenic shock identified by the research team.
“These early warning signs can help health care team members rapidly identify the signs and symptoms of cardiogenic shock.”
The EARLY SHOCK score is a matrix that first responders and medical staff can use to assess a patient’s risk of developing cardiogenic shock. The eight variables included in the score are a patient’s: 1) heart rate, 2) systolic blood pressure and 3) age. The score also looks at: 4) whether the patient experienced cardiac arrest, 5) the location of the blockage in the heart, 6) the patient’s history of heart failure, 7) whether the patient has diabetes and 8) whether the patient receives renal replacement therapy for kidney failure.
“Hospitals across North America have begun assembling specialized, multidisciplinary cardiogenic shock teams to treat patients with this condition,” shares Fordyce. “The EARLY SHOCK score can help to streamline this process, giving hospitals more time to assemble shock teams for emergency patient care.”
“The EARLY SHOCK score can help with triaging patients, reducing delays to care.”
Fordyce and his team are in the midst of validating EARLY SHOCK in a multi-centre study of STEMI patients. Ultimately, the team hopes to develop a printable pocket card or one-pager, and digital version of an EARLY SHOCK score to share with first responders and health care teams.
“Every minute makes a difference,” says Fordyce. “The greatest difference in patient outcomes often occurs within the first hour of presentation with STEMI or cardiogenic shock.”
