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

2. 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.

3. DETROIT CARDIOGENIC SHOCK INITIATIVE DETROIT CSI

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

6. CSI Detroit – Quality Measures

7. CSI Detroit – Inclusion and Exclusion Criteria

8. CSI Detroit Treatment Algorithm

9. CSI Detroit Treatment Algorithm – Hemodymanics and Escalation

10. CSI Detroit Treatment Algorithm – Weaning or Escalation

11. 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%

12. Hemodynamics SBP 79.6 DBP 53.7 MAP 61.1 Lactate Median 4.2 Average 4.6
Range

13. 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)

14. 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 ( 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

15. 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)

16. 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)

17. Thank you!