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PubMed This is a summary of 20 peer-reviewed journal articles Updated
Critical Care Medicine

Building Your Care Team: Navigating the ICU and Shock Teams

At a Glance

Patients in cardiogenic shock are treated by a multidisciplinary "Shock Team" in the ICU. This specialized team acts quickly to deploy life-saving treatments like ECMO. Families can track daily goals, monitor lactate trends, and communicate closely with critical care specialists to gauge progress.

The Cardiac Intensive Care Unit (ICU) can feel like a foreign country with its own language and a confusing number of “citizens.” When a loved one is in cardiogenic shock, they are no longer cared for by a single doctor, but by a high-stakes, specialized group often called a Shock Team [1][2].

What is a “Shock Team”?

A Shock Team is a “combat-style” multidisciplinary group that works 24/7 to make rapid, life-saving decisions [1]. Instead of waiting for one specialist to call another for a “consult,” these experts meet simultaneously to decide on the best treatment strategy, such as which heart pump to use or when to perform surgery [3][4]. Hospitals with formal Shock Teams often see better survival rates because they can act faster and more cohesively [5][6].

The Key Players in the ICU

You will see many people at the bedside. These are the specialized roles you should know:

  • Intensivist (Critical Care Physician): These doctors specialize in the overall management of ICU patients. They focus on the “big picture,” managing the lungs, kidneys, and blood pressure while the heart recovers [1][7].
  • Interventional Cardiologist: The “plumber” and “technician.” They are the specialists who perform procedures to open blocked arteries and physically place heart pumps (like the Impella) into the body [8][1].
  • Perfusionist: If your loved one is on a life-support machine like ECMO, the Perfusionist is the highly trained specialist who manages that machine’s settings, monitors blood flow, and ensures the “circuit” is working safely [8][9].
  • Cardiac Surgeon: These specialists are part of the team in case the patient needs emergency heart surgery or if a more permanent heart assist device is required [2].
  • ICU Nurse: Your primary point of contact. They monitor every heartbeat, medication drip, and machine alarm 24 hours a day [10].

Tracking Progress: Your Information Log

The ICU moves fast. To stay informed and help the team, many families find it helpful to keep a “Daily Goal Log” [10][11]. You don’t need to understand every medical detail, but you can track these four “artifacts”:

  1. The Daily Goal: Every morning during “rounds,” ask the nurse, “What is the #1 goal for today?” (e.g., “Starting to lower the blood pressure meds” or “Keeping the kidneys working”) [11].
  2. Lactate Trends: Ask for the latest lactate level. As the heart recovers, this number should generally go down [12].
  3. Machine Settings: Note if the “support level” on machines like the Impella or ECMO is being turned down. This is called weaning and is a sign of progress [13].
  4. Organ Milestones: Ask about “urine output” and “mental alertness.” These are the two best ways to tell if the body’s organs are finally getting enough blood [14][15].

Evaluating the Hospital’s Expertise

Not every hospital has the same level of equipment or experience for cardiogenic shock [16]. If your loved one is at a smaller hospital, the Shock Team may recommend a transfer to a specialized “hub” hospital that treats a high volume of these cases [17][18]. Do not be afraid to ask, “Is this facility an ECMO-capable center or a Level 1 Shock Center with the advanced mechanical support needed if my loved one’s condition worsens?” [19][20].

“Goals of Care” Conversations

Because cardiogenic shock is highly lethal, the medical team will likely ask you to participate in “Goals of Care” meetings. These are incredibly difficult conversations where doctors will discuss the patient’s chances of survival and what their quality of life might look like. They may ask what your loved one would want if their organs cannot be saved (such as discussing Do Not Resuscitate or DNR orders). While terrifying, these conversations are a standard and necessary part of ICU care to ensure the patient’s wishes and dignity are respected.

Common questions in this guide

What is a cardiogenic shock team?
A shock team is a specialized, multidisciplinary group of experts that works around the clock to make rapid, life-saving decisions. They collaborate simultaneously to decide on the best treatment strategy, such as when to place a heart pump or perform emergency surgery.
Who manages the ECMO machine in the ICU?
A perfusionist is the highly trained specialist responsible for managing complex life-support machines like ECMO. They monitor the blood flow, adjust the machine's settings, and ensure the bypass circuit operates safely while your loved one's heart recovers.
How can I track my loved one's progress in the cardiac ICU?
You can track recovery by asking the care team about the daily medical goal, watching for decreasing lactate levels, and checking if machine support is being lowered. Signs of organ recovery, like increased urine output and improved mental alertness, are also key milestones.
Does every hospital have a cardiogenic shock team?
No, not all hospitals have the specialized equipment or formal shock teams required to treat cardiogenic shock. Smaller facilities often transfer patients to dedicated Level 1 Shock Centers that regularly handle a high volume of these complex cases.
What is the role of an intensivist in cardiac care?
An intensivist is a critical care doctor who oversees the overall management of a patient in the intensive care unit. While cardiologists focus specifically on the heart, the intensivist manages the lungs, kidneys, and blood pressure to ensure the entire body is supported.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Does this hospital have a formal, 24/7 'Shock Team' that was activated for my loved one?
  2. 2.Which specialist is the 'lead' for coordinating the different teams (Cardiology, Surgery, and ICU)?
  3. 3.How many patients with cardiogenic shock does this center treat every year?
  4. 4.Is there a Perfusionist available on-site at all times in case the mechanical support needs adjustment?
  5. 5.When are the multidisciplinary rounds held, and how can I receive a summary of the daily goals?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (20)
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    'Combat' Approach to Cardiogenic Shock.

    Truesdell AG, Tehrani B, Singh R, et al.

    Interventional cardiology (London, England) 2018; (13(2)):81-86 doi:10.15420/icr.2017:35:3.

    PMID: 29928313
  2. 2

    A team-based approach to patients in cardiogenic shock.

    Doll JA, Ohman EM, Patel MR, et al.

    Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions 2016; (88(3)):424-33 doi:10.1002/ccd.26297.

    PMID: 26526563
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    Implementation of a Cardiogenic Shock Team and Clinical Outcomes (INOVA-SHOCK Registry): Observational and Retrospective Study.

    Tehrani B, Truesdell A, Singh R, et al.

    JMIR research protocols 2018; (7(6)):e160 doi:10.2196/resprot.9761.

    PMID: 29954728
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    Implementation of a Multidisciplinary Cardiogenic Shock Team in a Nonacademic Canadian Heart Centre: An Implementation Study.

    El-Mughayyar D, Marshall T, D'Souza K, et al.

    CJC open 2025; (7(2)):231-238 doi:10.1016/j.cjco.2024.11.007.

    PMID: 40060208
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    Improving Cardiogenic Shock Team Activation Through Nurse Education and Alert Implementation.

    Krais S, Sheasby J, Banwait J, et al.

    Critical care nurse 2024; (44(6)):24-30 doi:10.4037/ccn2024259.

    PMID: 39615540
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    Impact of a Cardiogenic Shock Program on Mortality in a Non-Transplant Hospital.

    Aboal J, Pascual J, Loma-Osorio P, et al.

    Heart, lung & circulation 2024; (33(1)):38-45 doi:10.1016/j.hlc.2023.11.010.

    PMID: 38151398
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    Microaxial flow pump in cardiogenic shock: a retrospective cohort study on outcomes and feasibility as a bridge to LVAD implantation.

    Balder JW, Kraaijeveld A, Szymanski M, et al.

    Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation 2025; (33(7-8)):226-231 doi:10.1007/s12471-025-01963-2.

    PMID: 40608285
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    Monitoring MCS patients on the intensive care unit: integrating haemodynamic assessment, laboratory data, and imaging techniques for timely detection of deterioration and recovery.

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    PMID: 38093766
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    Outcomes after extracorporeal life support for postcardiotomy cardiogenic shock.

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    Journal of cardiac surgery 2019; (34(2)):74-81 doi:10.1111/jocs.13985.

    PMID: 30636172
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    Improving Communication and Workflow Among Advanced Practice Providers and Nurses on Night Shift in an Intensive Care Unit.

    Massey CAD, Selph MJ, Mitchell S

    Critical care nurse 2025; (45(1)):36-51 doi:10.4037/ccn2025358.

    PMID: 39889802
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    Intervention Codesign in the Pediatric Cardiac Intensive Care Unit to Improve Family Meetings.

    Walter JK, Hill D, Drust WA, et al.

    Journal of pain and symptom management 2022; (64(1)):8-16 doi:10.1016/j.jpainsymman.2022.03.010.

    PMID: 35339610
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    Lactate Clearance Is Associated With Improved Survival in Cardiogenic Shock: A Systematic Review and Meta-Analysis of Prognostic Factor Studies.

    Marbach JA, Stone S, Schwartz B, et al.

    Journal of cardiac failure 2021; (27(10)):1082-1089 doi:10.1016/j.cardfail.2021.08.012.

    PMID: 34625128
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    Escalating and De-escalating Temporary Mechanical Circulatory Support in Cardiogenic Shock: A Scientific Statement From the American Heart Association.

    Geller BJ, Sinha SS, Kapur NK, et al.

    Circulation 2022; (146(6)):e50-e68 doi:10.1161/CIR.0000000000001076.

    PMID: 35862152
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    Patterns of Disease Progression and Outcomes of Inferior ST-Elevation Myocardial Infarction Complicated by Cardiogenic Shock: The Multicenter INSTINCT Registry.

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    Journal of clinical medicine 2025; (14(7)) doi:10.3390/jcm14072231.

    PMID: 40217681
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    Kidney and liver dysfunction in cardiogenic shock.

    Lassus J

    Current opinion in critical care 2020; (26(4)):417-423 doi:10.1097/MCC.0000000000000746.

    PMID: 32520812
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    Regional Variation in the Management and Outcomes of Acute Myocardial Infarction With Cardiogenic Shock in the United States.

    Vallabhajosyula S, Patlolla SH, Dunlay SM, et al.

    Circulation. Heart failure 2020; (13(2)):e006661 doi:10.1161/CIRCHEARTFAILURE.119.006661.

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    Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association.

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    Cardiac Shock Care Centers: JACC Review Topic of the Week.

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This page provides educational information about cardiac ICU care teams and cardiogenic shock navigation. It is not medical advice; always defer to your loved one's intensive care team for specific prognostic and treatment decisions.

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