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
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CARDIOGENIC SHOCK
A CHANGE IN PARADIGM
DOOR TO BALLOON
DOOR TO SUPPORT
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CSI DETROIT – QUALITY MEASURES
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CSI DETROIT – INCLUSION AND EXCLUSION CRITERIA
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CSI DETROIT TREATMENT ALGORITHM
CSI DETROIT TREATMENT ALGORITHM – HEMODYMANICS AND ESCALATION
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CSI DETROIT TREATMENT ALGORITHM – WEANING OR ESCALATION
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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
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Pre-Impella Support
No
Pressors/Ino…
Pressors
and IABP
10%
IABP
3%
Pressors
67%
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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)
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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
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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)
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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)
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Thank you!