Defining a Cardiogenic Shock Center and Its Relationship to Outcomes Among Patients With Cardiogenic Shock　― A Scoping Review ―

Abstract

Despite advances in the treatment of cardiogenic shock (CS), it remains associated with high mortality rates. To improve patient outcomes, management in a dedicated care center has been proposed. However, the definition of a dedicated CS center has not been systematically examined, and no consensus exists across major societies or guidelines. The aim of this scoping review was to identify key elements defining CS centers linked to better patient outcomes and guide future research. This review was conducted in accordance with the PRISMA extension for scoping reviews. The PubMed, Cochrane, and Web of Science electronic databases were systematically searched to identify studies published from inception to July 19, 2023. Twenty observational studies examining hospital characteristics and patient outcomes with CS were included. Higher volumes of CS patients, more board-certified cardiologists, percutaneous coronary intervention (PCI) availability 24/7, and the presence of cardiovascular intensive care units, left ventricular assist device (LVAD) centers, and hub-and-spoke systems were associated with better outcomes. Inconsistent associations were observed for the number of PCIs, extracorporeal membrane oxygenation, and percutaneous microaxial ventricular assist device procedures, and LVAD case volume and the availability of cardiac surgical support were not associated with improved outcomes. This scoping review identified candidate elements of CS centers linked to better outcomes, providing a foundation for developing an optimal CS care system.