Detroit Cardiogenic Shock Initiative

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Presentation transcript:

Detroit Cardiogenic Shock Initiative Theodore L. Schreiber, MD, FACC, FASCI, FCCP President, Detroit Medical Center Heart Hospital

Disclosure Statement of Financial Interest I, Theodore L. Schreiber, MD, DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation.

DETROIT CARDIOGENIC SHOCK INITIATIVE DETROIT CSI

CARDIOGENIC SHOCK A CHANGE IN PARADIGM DOOR TO BALLOON DOOR TO SUPPORT

CSI Detroit – Quality Measures

CSI Detroit – Inclusion and Exclusion Criteria

CSI Detroit Treatment Algorithm

CSI Detroit Treatment Algorithm – Hemodymanics and Escalation

CSI Detroit Treatment Algorithm – Weaning or Escalation

Results of Pilot Study July, 2016 – January, 2017 N = 30 Sites: St Joseph's (Pontiac) (N=10) Beaumont Royal Oak & Troy (N=9) Henry Ford (N=6) Detroit Medical Center (N=5) Demographics Age 63 +/- 13 years (36-87) 80% Male, 20% Female Diabetics 48%

Hemodynamics SBP 79.6 DBP 53.7 MAP 61.1 Lactate Median 4.2 Average 4.6 Range 1.5 - 16

Pre-Procedural Characteristics Transfer from outside hospital 31% (N=9/29) 4 patient transported with IABP 26% (N=8/30) In Hospital Cardiac Arrest 23% (N=7/30) Required CPR 67% presented to hospital in shock (N=19/28)

Procedural Characteristics 4 patients under active CPR at the time of Impella implantation 75% survival (N=3/4) Duration of Shock (N=20) 58 mins (20 - 229 minutes) Door to Balloon Time (N=16) 64 minutes AMI to Shock Time (N=13) 93 minutes Shock to Device Time (N=23) 64.6 minutes (8-229) Impella Timing (N=29) PrePCI 65% PostPCI 28% Intraprocedure 7% Impella Type (N=29) CP 97% RP 3% 100% Femoral Access

Procedural Characteristics 100% successful PCI Pre Procedure TIMI Score 74% TIMI 0 (n=27) Post Procedure TIMI Score (n=27) 81% TIMI 3 55 % thrombectomy (n=16/29) 82% RHC use (n=12/28)

Procedural Survival 93 % (N=28/30) Survival to Discharge 80% (N=24/30) Outcomes Cardiac Power 0.59 (Pre) (n=14) 0.71 (Post) (n=20) Procedural Survival 93 % (N=28/30) Survival to Discharge 80% (N=24/30)

Thank you!