Abiomed’s Cardiogenic Shock Guidelines

The use of standardized protocols has been associated with improvement in outcomes for people in cardiogenic shock. Such protocols enable clinicians to quickly assess a situation and rapidly decide on next steps. These protocols present Abiomed’s cardiogenic shock guidelines and include best practices to identify, stabilize, revascularize, and reassess high-risk cardiogenic shock patients. Inserting mechanical assist devices such as Impella® heart pumps early and before percutaneous coronary intervention (PCI) have contributed to improved patient outcomes. These protocols detail the processes of escalation, weaning, and transfer of patients. These cardiogenic shock guidelines were developed as a best practice guide for physicians and healthcare workers in hospitals to use to treat critically ill patients in acute myocardial infarction (AMI) cardiogenic shock.

Abiomed Cardiogenic Shock Protocol

The first protocol entitled “Impella® Best Practices in AMI Cardiogenic Shock” helps the clinician rapidly assess the patient with suspected acute myocardial infarction for signs of cardiogenic shock, which must be recognized immediately. Cardiogenic shock is identified by hypotension (90 mm Hg), tachycardia, EKG changes, elevated serum lactate levels (> 2mmol/L), and decreased urine output. Traditional modalities such as echocardiography and EKG are enormously helpful as are the use of pulmonary artery catheters. Monitoring of vital parameters such as cardiac output, urine output, lactate, rhythm and blood pressure in addition to the ability to be weaned from pressors is included.

Once this critically ill patient has been identified (Identify: Minimize Duration of Shock protocol), rapid transit to the cardiac cath lab for stabilization and reperfusion therapy has been and remains the gold standard for treatment (Stabilize Early and Complete Revascularization protocol). Pre-revascularization hemodynamic support with the Impella 2.5® or Impella CP® has been associated with improved hemodynamics by unloading the left ventricle prior to revascularization and also with a favorable impact on survival (Predictors of Survival at 12-24 hours on Impella). Minimizing the use of vasopressors, which can drive arrhythmias and worsen ischemia is an added benefit of pre-percutaneous coronary intervention (PCI) mechanical support.

Complete and successful revascularization of the infarct vessel remains critical to outcomes. Once the culprit vessel is opened and hemodynamics are assessed, post myocardial infarction critical care is implemented and continued hemodynamic support is provided (Escalation, Weaning, and Transfer protocol). In the sickest of post-myocardial infarction patients Impella support has been shown to improve patient outcomes.

Patients are reassessed prior to discharge from the cardiac cath lab (Reassess Prior to Discharge from Cath Lab protocol). Those who make good progress are assessed for signs of myocardial recovery and removal of cardiac support. Those who do not may need additional Impella support on the right (Impella RP®) or left (Impella 5.0®) side (No Recovery: Escalate (&Ambulate) or Transfer protocol) or may require the use of extracorporeal membrane oxygenation (ECMO) with Impella (Impella® with ECMO Strategy protocol).

All of Abiomed’s cardiogenic shock guidelines were developed for clinicians and healthcare workers in hospitals to quickly assess patient progress and guide decision making in all stages of cardiogenic shock. These best practices and standardized protocols have been shown to improve patient outcomes from cardiogenic shock.