Clinicians at Royal Brompton and Harefield hospitals (RB&HH) have developed a programme to improve the survival of patients with cardiogenic (heart) shock. This is the first comprehensive cardiogenic shock service in the UK.
Cardiogenic shock is a life-threatening condition, where the heart is unable to pump a sufficient amount of blood around the body, leading to progressive and rapid failure of all the organs, and is associated with a high risk of death. The condition is most often caused by a severe heart attack and is currently the most common reason people die after suffering a heart attack, but a number of other conditions can also cause cardiogenic shock. If it is recognised early enough, appropriate specialist intervention significantly increases the chances of survival. If not, patients can deteriorate very rapidly and may not survive.
Cardiogenic shock affects an estimated 10,0001 people of all ages each year in the UK. Currently, there is no dedicated national pathway in the UK for cardiogenic shock patients. However, this new programme developed by the teams at RB&HH means that specialist expertise and technology is immediately available to patients no matter where they are, across the UK.
The RB&HH Shock Programme consists of two main components. First, if cardiogenic shock is suspected, clinicians around the country can access expert advice on treatment from RB&HH’s Shock Team, including advice on the need for highly specialist treatments that are only available at a few hospitals. This input comes through an emergency virtual multidisciplinary team meeting, linking experts from RB&HH to the treating clinicians at remote centres, enabling review of diagnostic tests and facilitating optimal decision-making at the earliest possible stage.
Second, in circumstances where highly specialist treatment is required, the RB&HH Shock Team deploy their rapid response vehicle to wherever their specialist expertise is needed in order to institute highly specialist life-saving support to stabilise the patient and bring them safely to a specialist hospital for ongoing treatment.
Professor Susanna Price, consultant cardiologist and intensivist and lead for the service, said: “Cardiogenic shock represents one of the most critical cardiac conditions, and demands some of the most complex interventions within cardiology and cardiac intensive care. As specialist heart hospitals, we recognised the role we could play together in improving immediate access to specialist knowledge in this area, and so provide a service that would benefit the diagnosis and management of patients with cardiogenic shock.
“Royal Brompton and Harefield hospitals are uniquely placed to be able to offer this service as we have all the required expertise to provide assessment and management for the full range of complex cardiac conditions up to and including congenital heart disease, inherited cardiac conditions, heart disease in pregnancy, and cardiac transplantation. This, together with our long history in provision of extracorporeal mechanical circulatory support means we can provide the full range of acute and advanced cardiac interventions that a cardiogenic shock patient may need to survive. All of this expertise in one place is rare, so we saw an opportunity to build on existing pathways, rapidly convening experts from multiple teams to work with referring clinicians in order to help as many patients as possible across the country.”
David Randall’s wife, Christina, suffered from cardiogenic shock in February this year. Moments after a planned caesarian section at Watford General Hospital, Christina’s heart failed due to an amniotic fluid embolism, a rare but serious condition where the amniotic fluid that surrounds a baby in the womb during pregnancy enters the mother's bloodstream. Royal Brompton’s Shock Team retrieved her from Watford and took her back to Royal Brompton Hospital where she was placed on extracorporeal membrane oxygenation (ECMO), a life-support machine that takes over the function of the heart and lungs by pumping oxygenated blood around the body while a patient recovers.
David said: “I was still holding Christina’s hand after the baby was delivered, when she turned to me and said she couldn’t breathe. Watford said they would need to move her to Royal Brompton, but that she might not survive the journey. When I heard that, my world crumbled. People always tell me it’s a miracle Christina survived, but it’s definitely not. It’s thanks to the experts at Royal Brompton, and for Watford for knowing who to call when it happened, that she survived. I was so grateful when she was home with me and the kids after just two weeks.”
Dr Vasileios Panoulas, Harefield consultant cardiologist and interventional lead for the programme, said: “Cardiogenic shock patients are some of the sickest patients in the country, so it is fantastic that we are able to offer this vital service by collaborating with colleagues around the UK. This is just one of the great examples of how Royal Brompton and Harefield combine their specialist expertise to improve the outcomes of these truly sick patients.”
Notes to editor
1) https://healthcare-in-europe.com/en/news/first-use-of-vasoprotective-antibody-in-cardiogenic-shock.html figure based on UK making up 10% of the total population of USA and Europe.
The symptoms of cardiogenic shock, such as unresponsiveness and breathlessness, are often mistaken for other conditions, for example sepsis. The treatment for cardiogenic shock varies but in the most severe cases requires ECMO (where a machine takes over the function of the heart and lungs to pump oxygenated blood around the body) and even a heart transplant. There are only five adult ECMO centres in the UK and seven heart transplant centres. The RB&HH Shock Programme currently receives 20 to 40 referrals per month from a range of areas including primary, secondary and tertiary centres, general practice among others.
The RB&HH Shock teams is made up of:
- Cardiologists, including interventional cardiologists, and specialists in pulmonary hypertension, heart failure and inherited cardiac conditions
- Intensivists
- Cardiac surgeons
- Perfusionists
- ECMO nurses
- Transplant surgeons
- Obstetricians