WellStar Hub and Spoke Cardiogenic Shock Treatment Network

October 4, 2019

Successful Implementation of Cardiogenic Shock Algorithm

Dr. Salvatore Mannino discusses the cardiogenic shock algorithm used in his successful spoke and hub network. Dr. Mannino is director of the short-term mechanical circulatory support program at WellStar Health System, the largest healthcare system in Georgia.

Starting in 2016, each hospital in the WellStar spoke and hub network began following the same cardiogenic shock algorithm. Dr. Mannino explains that this algorithm "gives us a framework of how to take care of these patients. It allows us to speak the same language, communicate with each other, and have a specific plan for each patient." He then shows that they've seen significant improvement in cardiogenic shock survival since implementing the algorithm.

Dr. Mannino presents a case in which the algorithm helped a patient presenting at a spoke hospital receive timely biventricular Impella® support at the hub hospital. He discusses the underrecognized condition of post-cardiac arrest myocardial dysfunction, occurring in 2/3 of patients after cardiac arrest. He explains that it is generally reversible within 48 hours if the patient can maintain tissue perfusion, which, in this patient, required mechanical circulatory support.

"This illustrates the importance of having a pathway for all these patients,” Dr. Mannino tells interviewer Dr. Dan Raess. “There was early recognition that this patient was not doing well. There was immediate transfer. We put in left-sided support. We waited. We didn't wait days to go to right-sided support. The patient had quick, aggressive therapy, as indicated, and he did very, very well."

Dr. Mannino also emphasizes the importance of hemodynamic data from a PA catheter. “No one in our cath lab with an Impella leaves without a PA catheter,” he explains. “The data clearly shows an association between PA catheter use and survival in shock patients.

Dr. Mannino discusses some of the challenges and issues raised with the rollout of the cardiogenic shock algorithm in his network. "That's where the whole spoke and hub model became so important, because these patients need to be taken care of at a center that has a whole spectrum of therapy. And when our group started to see the outcomes, is when this really took off. Once you see a patient of yours that you didn't think was going to make it and they walk out of the hospital and you see them in the office 3 months later… I mean, that's what this is about."

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To learn more about the Impella® platform of heart pumps, including important risk and safety information associated with the use of the devices, please visit: www.protectedpci.com/indications-use-safety-information/

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