Reply To: Shock Center Definitions
V4 definitions (Courtsey GC and CM):
Tiered Approach to Cardiogenic Shock Centers
Level I – Comprehensive Shock Centers: Highest level of cardiogenic shock capability
* Level I-A: Comprehensive Advanced HF & Transplant: Highest regional capability
* Level I-B – Advanced Surgical & ECMO Shock Center: Comprehensive acute shock management without transplant
Level II – Advanced Shock Centers: High-level capability but limited surgical/MCS spectrum
Level III – Stabilization Shock Centers: Stabilize and transfer model
Level IV – Shock Recognition & Transfer Centers
Tiered Approach to Cardiogenic Shock Centers
Level I – Comprehensive Shock Centers:Â
Highest level of cardiogenic shock capability
24/7 Interventional Cardiology (primary PCI capable)
24/7 Cardiac Surgery
Full spectrum Advanced Mechanical Circulatory Support (MCS):
pLVAD/pRVAD
Surgical pVAD
VA-ECMO(and various configurations – structural IC for septostomy/LAVA)
Structured shock protocol (SCAI staging integrated)
Dedicated Shock Team activation system
Cardiac ICU with shock expertise
Advanced ICU hemodynamic monitoring (Swan, lactate protocols, etc.)
24/7 ancillary consultative services (Vascular surgery, NSGY, etc.)
Multidisciplinary team:
Advanced HF
Cardiac surgery
ECMO specialists
Perfusion support
Ability to accept regional transfer
Expected Role:
Data reporting to consortium registry
Regional referral hub
Escalation center
Lead education & quality initiatives
Level I-A: Comprehensive Advanced HF & Transplant
Highest regional capability
Required Capabilities
24/7 Interventional Cardiology
24/7 Cardiothoracic Surgery
Full Mechanical Circulatory Support (MCS) spectrum:
All tiers pVAD (including surgical pVAD e.g. impella 5.5)
VA-ECMO
Durable LVAD implantation program
Active Heart Transplant (HTX) program
Advanced Heart Failure team onsite
Dedicated Shock Team activation protocol
Cardiac ICU with advanced shock expertise
ECMO specialists and perfusion support
Advanced hemodynamic monitoring protocols
Ability to accept regional transfers 24/7
System Role
Regional referral hub
Destination therapy center
Transplant and durable MCS decision center
Consortium leadership, education, and registry participation
Level I-B – Comprehensive Shock Center Comprehensive acute shock management without transplant Required Capabilities
24/7 Interventional Cardiology
24/7 Cardiothoracic Surgery
All tiers pVAD (including impella 5.5)
VA-ECMO initiation (and management onsite preferably)
Structured Shock Team activation protocol
Cardiac ICU capable of advanced MCS management
Formalized transfer pathway to Level I-A for transplant/LVAD
May Not Include
Durable LVAD program
Heart transplant program
System Role
Full acute stabilization center
ECMO initiation and management
Regional escalation partner to Level I-A
Level II – Advanced Shock Centers High-level capability but limited surgical/MCS spectrum
Must Have:
24/7 PCI capability
pVAD capability (pLVAD/RVAD)
Structured shock protocol
Shock team activation (formal or informal)
Cardiac surgery(limited surgical MCS e.g. initiate ECMO)
Cardiac ICU capability
Established transfer pathway to Level I center
May Not Have:
24/7 ECMO
24/7 cardiac surgery
Advanced HF/transplant capability
Expected Role:
Initial stabilization
Early MCS initiation
Rapid escalation/transfer if needed
Participation in regional protocol alignment
Level III – Stabilization Shock Centers: Stabilize and transfer model
Must have:
Emergency department recognition protocols
24/7 PCI Capability
Ability to initiate:
Vasopressors/inotropes
Limited pMCS(e.g. pLVAD or IABP)
Defined transfer agreement with Level I/II center
Expected Role:
Early recognition
Early SCAI staging
Rapid activation of regional transfer
No expectation of advanced MCS capability
Level IV – Shock Recognition & Transfer Centers:
Early recognition
SCAI shock staging protocol implemented
Lactate and shock biomarker protocol
ED and ICU shock screening pathway
STEMI/NSTEMI recognition pathway
Initiation Stabilization
Vasopressors and inotropes available
Arterial line capability
Central venous access capability
Ventilator management