{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T20:44:04Z","timestamp":1789073044254,"version":"build-2803163510"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,3,4]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Cardiogenic shock carries high mortality. This study investigated the relationship between protocol\u2010advocated best practices and outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">Patients with cardiogenic shock supported by Impella CP in an Asian tertiary cardiac center were evaluated for 30\u2010day post percutaneous ventricular assist device (PVAD) survival after adopting a standardized protocol emphasizing early mechanical circulatory support (shock\u2010to\u2010PVAD time \u2264180\u2009minutes), pulmonary artery catheterization for invasive hemodynamics, and safe vascular access.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Of 109 consecutive patients (mean age 58.5\u00b111.2, 80.7% male, 67% acute myocardial infarction, 33% acute decompensated heart failure), 45 (41.3%), 33 (30.3%), and 31 (28.4%) were in SCAI Shock Stages C, D, and E, respectively. A suggestive trend of improving 30\u2010day survival was observed (56.8%, 63.9%, and 72.2% in successive one thirds, P1, P2, and P3 of patients), paralleling a similar trend in achievement of best practices. Patients achieving all 3 best practices significantly increased from 35.1% (P1) to 52.8% (P3) (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.026). Median shock\u2010to\u2010PVAD time reduced from 5 [interquartile range: 2\u201323] hours (P1) to 1.5 [1\u20135] hours (P3) (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      for trend=0.014), whereas pulmonary artery catheterization utilization (80.6\u201386.1%) and device\u2010related major vascular complications (5.6\u20138.4%) remained relatively stable. Achieving more best practices was significantly associated with better 30\u2010day survival, with patients achieving all 3, 2, and \u22641 best practices had 30\u2010day survival rates of 75.0%, 63.6%, and 35.7%, respectively (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.043). In multivariate Cox regression analysis, shock\u2010to\u2010PVAD time &gt;180\u2009minutes remained an independent predictor of mortality (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.031).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Achievement of protocol\u2010advocated best practices, especially early shock recognition and prompt PVAD support in appropriate patients, was associated with improved outcomes with PVAD use in cardiogenic shock. Future studies are suggested to confirm the benefits of a protocolized approach and evaluate the value of individual best practices.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.124.037742","type":"journal-article","created":{"date-parts":[[2025,2,26]],"date-time":"2025-02-26T06:09:49Z","timestamp":1740550189000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Protocol\u2010Driven Best Practices and Cardiogenic Shock Survival in Asian Patients"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-8272-7976","authenticated-orcid":false,"given":"Calvin","family":"Leung","sequence":"first","affiliation":[{"name":"Queen Elizabeth Hospital","place":["Hong Kong SAR"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2936-1777","authenticated-orcid":false,"given":"Yan 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