Survey – STL Shock Consortium

The STL Shock Consortium is conducting a targeted assessment of regional cardiogenic shock capabilities among leadership programs to improve coordination, referral pathways, and patient outcomes.

This survey takes less than 3 minutes. No patient information is collected.

Your Full Name *

Your Email Address *

Primary Hospital / Center Where You Manage Cardiogenic Shock *

If transferring a cardiogenic shock patient, where is your preferred referral center? *

Would you be willing to participate in a regional shock leadership workgroups? *Yes – actively interestedYes – observer onlyPossiblyNot at this time

If you cannot serve on a workgroup, would you like to nominate a colleague?YesNo

Name of nominee

Email of nominee

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