AMI Cardiogenic Shock
ACC/AHA Upgrades mAFP to Class 2a and Downgrades IABP and VA-ECMO to Class 3 in patients with STEMI and Cardiogenic shock
The new Acute Coronary Syndrome (ACS) guidelines downgrade intra-aortic balloon pump (IABP) and venoarterial extracorporeal membrane oxygenation (VA-ECMO) to Class 3 due to no shown benefit, while microaxial intravascular flow pumps (mAFP), Impella®, is now Class 2a in patients with STEMI and severe or refractory cardiogenic shock.
DanGer Shock RCT
Published in the New England Journal of Medicine, confirms Routine Use of Impella® Improves Survival in Heart Attack with Shock1
Best Practice Protocols Include 1-4
- Identify CS early and Impella pre-PCI < 90 minutes
- Aggressive down-titration of inotropes
- Identify RV dysfunction early and support
- Identify inadequate LV support and escalate
- Systematic use of RHC to guide therapy
Final Results from the National Cardiogenic Shock Initiative (NCSI) Study Demonstrate the Benefit of Early Cardiac Unloading with Impella®
The NCSI study demonstrates a 71% survival to discharge with greater than 90% native heart recovery when best practices are used, including placement of an Impella heart pump prior to revascularization.
Patient Identification Resources from the Education Library
Improving Outcomes in Cardiogenic Shock Through Best Practices
Prior to discharge from the cath lab and in the ICU, reassess hemodynamics via PA catheter. Best practices include measuring cardiac power output (CPO) and pulmonary artery pulsatility index (PAPi) to evaluate the adequacy of left-sided Impella® support and right heart function, while reducing inotropes.
Online Calculators
Heparin-Free Purge Solution
Sodium bicarbonate is the preferred purge solution when heparin is of concern due to HIT or bleeding related to heparin.
Patient Manangement Resources from the Education Library
NPS-1306