STL Shock Consortium Advances a Regional Framework for Cardiogenic Shock Care

Clinicians, hospital leaders, coordinators, and other cardiovascular professionals from across Greater St. Louis, Central Illinois, and Southern Illinois gathered on August 27, 2026, for the STL Shock Consortium’s quarterly dinner meeting.

The meeting focused on a shared regional goal: ensuring that every patient with cardiogenic shock receives timely recognition, appropriate initial stabilization, and access to the level of care best suited to the patient’s clinical needs.

Participants represented multiple health systems, hospitals, specialties, and professional roles. The discussion reinforced the Consortium’s commitment to building an institution-independent, multidisciplinary network that supports collaboration across traditional organizational and geographic boundaries.

Building a Coordinated Regional System of Care

The STL Shock Consortium is developing a regional framework designed to connect hospitals with different capabilities through shared clinical principles, clearly defined roles, and reliable communication.

Four principles guide the proposed framework:

1. Defined roles across levels of care. Every participating hospital should understand its role in recognizing, stabilizing, treating, or transferring patients with cardiogenic shock.
2. Physiology-driven escalation. Transfer and escalation decisions should be based primarily on the patient’s clinical trajectory and hemodynamic needs—not simply geography or health-system affiliation.
3. Demonstrated capabilities. Center designations should reflect available expertise, processes, staffing, and the ability to deliver coordinated care rather than the presence of an individual device alone.
4. Shared accountability. The regional network should evaluate outcomes, access, timeliness, and equity while continuously improving how care is delivered.

The Consortium’s proposed levels-of-care model ranges from hospitals focused on early recognition and stabilization to comprehensive centers capable of providing advanced mechanical circulatory support, cardiac surgery, durable ventricular-assist devices, and heart transplantation.

This model is not intended to direct every patient to the same institution. Instead, it is designed to help each patient reach the most appropriate destination based on clinical condition, anticipated treatment needs, available capabilities, and capacity.

Earlier Recognition and Escalation

William O’Neill, MD, presented clinical evidence and operational lessons related to acute myocardial infarction complicated by cardiogenic shock.

The presentation emphasized that cardiogenic shock is a time-critical condition. Early identification, invasive hemodynamic assessment when appropriate, serial evaluation of perfusion, and rapid recognition of treatment failure can help teams make more timely decisions.

Discussion topics included:

• early assessment of shock severity and trajectory;
• the role of right-heart catheterization;
• cardiac power output and right-ventricular hemodynamics;
• lactate trends and other indicators of tissue perfusion;
• careful management of vasoactive medications;
• selection and timing of mechanical circulatory support; and
• escalation when a patient remains hypoperfused despite initial treatment.

Participants discussed the importance of moving beyond a single procedural time target toward a broader system that measures recognition, stabilization, support, reassessment, and escalation.

Cross-System Collaboration in Practice

A multidisciplinary case discussion demonstrated how early communication and collaboration between hospitals can support complex decision-making.

The case illustrated several principles central to the Consortium’s mission:

• stabilize the patient at the presenting hospital;
• recognize when the patient may require capabilities not available locally;
• communicate with potential receiving teams before further deterioration;
• share relevant imaging and hemodynamic information;
• select a destination that can address both immediate and anticipated needs; and
• avoid unnecessary sequential transfers when the likely definitive level of care can be identified early.

The discussion underscored that successful regional care depends on relationships and communication across institutions—not simply on technology or written transfer agreements.

Developing a Shared Regional Shock Protocol

The Protocol Workgroup is beginning a structured comparison of existing cardiogenic-shock pathways from hospitals across the region.

Participating institutions are invited to submit their current:

• cardiogenic-shock protocols;
• emergency department or catheterization-laboratory pathways;
• shock-team activation criteria;
• order sets;
• transfer algorithms; and
• mechanical circulatory support protocols.

The workgroup will identify areas of agreement, evaluate important differences, and develop a comprehensive regional framework informed by current evidence and local experience.

The resulting framework will be adapted to the capabilities of different hospitals. Community and rural hospitals may focus on early recognition, initial stabilization, consultation, and efficient transfer, while advanced centers may incorporate invasive monitoring, complex mechanical circulatory support, cardiac surgery, and other specialized services.

Building a Regional Quality Registry

The Consortium is also exploring participation in the American Heart Association’s cardiogenic-shock registry.

A shared registry could help participating hospitals:

• measure regional patterns of care;
• compare outcomes with relevant peer institutions;
• identify delays or gaps in treatment;
• evaluate access and equity;
• support quality-improvement initiatives; and
• generate data for future research and system planning.

Participants recognized that data abstraction and information-technology support will be major implementation considerations, particularly for smaller and rural hospitals. The Registry Workgroup will continue evaluating practical options for shared infrastructure and regional participation.

Improving Communication and Transfer Coordination

Reliable communication is essential when a patient’s condition is changing rapidly.

The Consortium is evaluating communication platforms that could support:

• one-call shock-team activation;
• early consultation between referring and receiving clinicians;
• secure exchange of clinical information, imaging, and hemodynamic data;
• multidisciplinary conferencing;
• transfer coordination; and
• identification of an appropriate receiving facility.

Pulsara and eBridge are among the platforms under consideration. No final platform has been selected. The evaluation will consider institutional adoption, interoperability, workflow, staffing, pricing, and the ability to support hospitals across multiple health systems.

The desired future state is a regional process in which a referring team can request assistance through a reliable channel, communicate the patient’s trajectory, and identify an appropriate destination without making a prolonged series of disconnected calls.

Governance and Regional Partnerships

The STL Shock Consortium is pursuing an institution-independent governance structure that can support educational programs, research, quality improvement, advocacy, and future grant-funded initiatives.

The Consortium also plans to expand collaboration with the Missouri and Illinois chapters of the American College of Cardiology and with other professional, public-health, and community partners.

Potential areas of collaboration include:

• professional education;
• regional quality improvement;
• rural and community-hospital engagement;
• clinical pathway development;
• research and publications;
• public-health policy;
• workforce and infrastructure support; and
• sustainable funding for regional coordination.

The Consortium will continue developing its organizational structure while ensuring that clinical and governance decisions remain independent and focused on patient and community needs.

Opportunities to Participate

The STL Shock Consortium welcomes participation from clinicians, nurses, coordinators, administrators, emergency medical professionals, data specialists, researchers, and other stakeholders committed to improving cardiogenic-shock care.

Current areas of participation include:

• Definitions and Levels of Care
• Clinical Protocols
• Registry and Quality Improvement
• Communication and Transfer Coordination
• Research and Publications
• Grants and Sustainability
• Advocacy and Public Policy
• Education and Communications

Broad participation is especially important from community and rural hospitals. The regional system must reflect the capabilities, needs, and experiences of every setting in which patients with cardiogenic shock may initially present.

Next Steps

Following the August meeting, the Consortium will focus on several near-term priorities:

1. Collect existing cardiogenic-shock protocols and transfer pathways from participating hospitals.
2. Identify hospitals interested in regional registry participation.
3. Continue evaluation of communication and transfer-coordination platforms.
4. Refine the proposed levels-of-care framework and regional capability directory.
5. Expand participation from community and rural hospitals.
6. Advance discussions with the Missouri and Illinois chapters of the American College of Cardiology.
7. Develop funding strategies to support coordination, education, data collection, and quality improvement.
8. Continue work toward an independent organizational and governance structure.
9. Establish the date and agenda for the next Consortium meeting.

Join the STL Shock Consortium

The progress made at this meeting reflects a shared belief: improving cardiogenic-shock outcomes will require coordinated action across hospitals, health systems, specialties, and state lines.

Clinicians and organizations interested in participating are encouraged to:

• join the Consortium mailing list;
• complete the membership and institutional-capabilities survey;
• volunteer for a workgroup;
• submit an existing cardiogenic-shock protocol; and
• participate in an upcoming Consortium meeting.