Transferring patients in cardiogenic shock remains one of the most complex and time-sensitive challenges in acute cardiovascular care. New insights presented at the American College of Cardiology conference (ACC.26) highlight how earlier decision-making, stronger coordination and innovative transport strategies are improving outcomes for these critically ill patients.
According to a presentation by Jason Grady, NRP, AACC, FSCAI, of Northside Hospital Heart Institute, the transfer process begins long before an ambulance arrives. Delays often begin when clinicians determine that a patient requires a higher level of care, underscoring the need for rapid recognition and clear transfer protocols.
A scenario outlined in the presentation underscores the risks. A 58-year-old patient with an anterior STEMI required escalation to mechanical circulatory support before transferring to a Level 1 shock center. During transport, complications including hypotension, bleeding and device-related issues occurred, illustrating the fragile nature of these patients and the importance of specialized care teams.
Experts note that transfers frequently fail due to system-level challenges, including delayed recognition of shock, unclear triggers for escalation and fragmented acceptance processes between facilities. Limited transport resources further complicate timely care.
Transport itself introduces significant clinical risk. Potential complications include bleeding, catheter dislodgement, loss of monitoring signals and even cardiac arrest. These dangers reinforce the need for highly trained transport teams familiar with advanced therapies such as mechanical circulatory support and ECMO.
Data also shows that experience matters. Higher-volume centers managing cardiogenic shock and mechanical circulatory support cases tend to achieve better outcomes, supporting the role of regionalized “shock hub” systems.
To address these challenges, hospitals are investing in coordinated shock teams, standardized protocols and simulation-based training to ensure every step of the transfer process is executed safely and efficiently. Prearranged agreements with transport providers and ongoing performance review are also critical components of a reliable system.
Innovative approaches are emerging as well. Some programs deploy highly experienced nurses or ECMO specialists directly to referring to hospitals using rideshare services, allowing advanced care to begin earlier and enabling standard ambulances to function as critical care transport units.
Ultimately, experts emphasize that improving shock transfers requires a systemwide approach.
Shock transfers are high-risk and time-sensitive, and success depends on early recognition, coordinated decision-making and investment in resources and training. By addressing these factors, health systems can improve both the speed and safety of care for patients in cardiogenic shock.
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