Regional Shock Capability Survey – Leadership 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 *Your Role *Interventional CardiologyHeart FailureCardiothoracic SurgeryCritical CareEmergency MedicineAdministratorShock CoordinatorOtherPrimary Hospital / Center Where You Manage Cardiogenic Shock *What treatments are currently available at your center? *Intra-aortic balloon pump (IABP)Impella CPImpella 5.5Impella RPVA-ECMOVV-ECMOTandemHeartDurable LVADHeart TransplantNoneOtherFor patients you insert devices/cannulate and transfer (“cannulate and ship”), which device is most commonly used? *IABPImpella CPImpella RPImpella 5.5VA-ECMOVV-ECMOTandemHeartWe do not insert devices/cannulate prior to transferOtherFor patients managed locally (“cannulate and recover”), which device(s) are used? *IABPImpella CPImpella RPImpella 5.5VA-ECMOVV-ECMOTandem HeartIf 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 timeIf you are willing to serve on a workgroup(s), please indicate which one(s)?DefinitionsDatabaseProject ManagementMembershipMeetingsPublicationGrantsIf you cannot serve on a workgroup, would you like to nominate a colleague?YesNoName of nomineeEmail of nomineeSubmitSave as DraftPlease do not fill in this field.
