Cardiogenic Shock Centers and Protocols for Acute Cardiovascular Care: Bridging the Gap Between Spoke and Hub Sites

Cardiogenic shock (CS) is a syndrome of low cardiac output associated with high inpatient morbidity and mortality. Studies have supported the early transfer of patients with CS from spoke sites to the nearest regional hub center, forming the basis for the "hub-and-spoke" model. Contemporary CS algorithms revolve around invasive hemodynamic monitoring and temporary mechanical circulatory support guided by a multidisciplinary CS team. However, these protocols have limited applicability to the majority of spoke sites due to the limitations of resources, equipment, and personnel, further contributing to inequities in CS care. In this review, we seek to provide a blueprint for a generalizable approach to CS, an algorithm for intrahospital care escalation based on CS severity, and an example protocol detailing stabilization and monitoring strategies, independent of multidisciplinary CS teams.