Shock Team Protocols with Dr. Truesdell and Dr. Tehrani

August 12, 2019

Can anyone do it? Absolutely!

Alexander Truesdell, MD, FACC, FSCAI, FSVM and Behnam Tehrani, MD, FSCAI, Medical Director, Cardiac Catheterization Laboratories at INOVA Heart and Vascular Institute, discuss their experience in adopting shock team protocols that have had a dramatic effect on survival and native heart recovery at their institution.

“Can anyone do it? Absolutely!” answers Dr. Truesdell in response to whether other hospital can replicate the extraordinary results seen at INOVA with the implementation of shock team protocols. Dr. Truesdell explains that implementing shock team protocols isn’t as labor intensive as one may think and doesn’t require a big infrastructure build. He emphasizes that it involves stepping up communication among people who are already there and doing their jobs. It also involves implementing small behavior changes that entail doing the right things earlier for the benefit of patients rather than scrambling later. The key challenge, Dr. Truesdell notes, is sustainability, which involves retraining and focusing on success to keep the whole team inspired.

Dr. Tehrani explains that they undertook the shock team protocol initiative after recognizing a lot of variation in practice patterns within the INOVA health system. After reviewing the outcomes, he notes, everyone agreed that something had to change. A review of data led to a consensus on practice patterns and development of easy to follow protocols. He hopes that the process and resulting protocols can serve as a blueprint for other health systems that want to implement similar principles and improve patient care.

The protocol at INOVA is based on principles such as minimizing the toxic burden of inotropes. While Dr. Truesdell notes that there is no cookie-cutter model for everyone, he emphasizes that at INOVA they evaluated what works and that turned out to entail:

  • Identification of shock states and not missing patients who are in shock
  • Hemodynamic assessments and “not guessing how a patient is doing”
  • Use of hemodynamics to guide therapy
  • Targeted times for reassessment and determining when people need mechanical circulatory support, and using MCS early
  • Benchmarks, such as patients not leaving the cath lab on pressors
  • Multidisciplinary team reviews

Dr. Tehrani expresses optimism for expanding the protocols to a broader group of hospitals, including small hospitals and community hospitals with fewer resources. He believes that all hospitals have the means to recognize disease process early and communicate with destination hospitals.

Dr. Truesdell describes his vision of a nationwide protocol to identify when patients are in shock and treat them earlier, identify best practices, and ensure everyone has a standardized care model.

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