Prof. Evgenij Potapov : SOPs for Cardiogenic Shock

Prof. Dr. med. Evgenij Potapov discusses standard operating procedures (SOPs) for cardiogenic shock with Dr. Armin Alexander Klesius at the annual meeting of the German Society of Thoracic and Cardiovascular Surgery in Hamburg, Germany in February 2023. Prof. Potapov is head of mechanical circulatory support, Deutsches Herzzentrum der Charité.

Prof. Potapov explains that the high mortality in patients with cardiogenic shock was the reason for creating SOPs to treat these patients at his institution. “We saw the possibility to improve this situation.” When comparing patients at his institution who were treated by following the SOP to historic patients or patient in whom the SOP was not followed, he states, “Patients in whom our standard operating procedure was applied have significantly better survival.”

Key elements of the SOP include fast implementation of mechanical circulatory support (MCS) by an experienced multidisciplinary team, which at his institution includes anesthesiology, intensivists, and cardiac surgery. The SOP focusses on LV unloading and management with a combination of ECLS (ECMO) and Impella heart pumps, also known as ECMELLA or ECpella.

Prof. Potapov explains that they determine the severity of cardiogenic shock by examining whether the patient required cardiopulmonary resuscitation (CPR) during index admission and whether the patient’s lactate level exceeds 8 mmol/L. In patients meeting both of these requirements, the team should implement a combination of ECLS and Impella heart pumps.

“Timely implementation of standard operating procedures is very important,” Prof. Potapov states, noting that when the shock team follows the SOP in a timely manner, “this contributes to improved survival.” He emphasizes, however, that it takes time to fully adopt such an SOP, especially in larger institutions. Education and propagation of successful results is important for getting everyone in the institution to understand, embrace, and follow the SOP.

His key message to other institutions seeking to implement cardiogenic shock SOPs: “Make your rules and then follow these rules, and then that will lead to improvement in survival.”