stlshock

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  • stlshock
    March 16, 2026 at 11:39 #1907

    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: 
    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

    stlshock
    March 5, 2026 at 23:07 #1816

    Survey open to all institutions in the region to gather information on capabilities and needs for care of cardiogenic shock patients. Please fill out the survey at:

    Survey

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