ACTACC Project Grant

St Bartholomew's Hospital, London

Title
A quantitative and qualitative analysis of the impact of a SHOCK team and structured SHOCK call system in the management of acute severe cardiogenic shock

Amount
£7,300

Scientific Abstract
Despite recent improvements in outcomes from cardiogenic shock (CS) due to early revascularization, significant opportunity remains to improve patient outcomes. Advances in technology, in particular the emergence of mechanical circulatory support, as well as a growing population of decompensated chronic heart failure patients has increased the complexity of decision making in CS. An integrated, multidisciplinary group, the SHOCK team, is recommended to appropriately and efficiently apply the various treatment options in CS care ranging from full mechanical support with veno-arterial ECMO through to palliative care.

Current systems of communication in medical emergencies, in particular CS, are inefficient and do not promote or facilitate immediate multi-specialty input to guide appropriate and rapid deployment of resource. SHOCK teams are mature in other healthcare systems but, hitherto, there has been a lack of rigorous examination of processes of care and patient outcomes.

We propose implementing an IT system to support multi-disciplinary decision-making in CS in parallel with the development of a defined SHOCK team. We plan to collect quantitative and qualitative data in 30 patients with CS at Barts Heart Centre, to determine the optimal structure and function of the SHOCK team and to test its clinical effectiveness.

Golden Jubilee National Hospital

Title
Right ventricular inflammation after lung resection

Amount
£12,358 (part-funded £4,658 from AAGBI/Anaesthesia)

Scientific Abstract
Lung cancer is the leading cause of cancer death within the UK. Surgical resection offers the best chance of cure but is associated with long-term dyspnoea and poor functional capacity. This is poorly associated with changes in respiratory function and maybe influenced by cardiac limitation.

Our research group have demonstrated that right ventricular (RV) function deteriorates following lung resection; a phenomenon widely believed to occur secondarily to increased afterload. In animal models acute increases in RV afterload stimulate neutrophil/macrophage infiltration leading to inflammation and fibrosis. Chronic increases in afterload lead to RV hypertrophy, paradoxical septal movement and RV failure. Our previous study also demonstrated increased afterload and paradoxical septal movement following lung resection.

We hypothesise that abrupt afterload changes occurring intra-operatively and early post-operatively trigger an acute inflammatory RV injury, which is sustained long into the post-operative period by altered flow dynamics within the pulmonary vasculature.

Fifteen patients will undergo sequential cardiac magnetic resonance with T1 mapping, a non-invasive method of assessing myocardial inflammation/fibrosis. We will assess the presence of post-operative RV inflammation and its association to post-operative RV dysfunction. Perioperative RV protection may provide a therapeutic opportunity, preventing RV dysfunction and ameliorating disabling decreases in functional capacity post-operatively.