When patients experience cardiogenic shock and their hearts can no longer meet the needs of the body, physicians can contact Froedtert & the Medical College of Wisconsin Froedtert Hospital to activate the cardiogenic shock process, proven to improve patients’ chances of survival.

According to Mitchell Saltzberg, MD, FACC, FAHA, FHFSA, advanced heart failure and transplant cardiologist, the shock process is typically launched if a patient’s blood pressure is so low that he or she needs one high-dose IV medication or two low-dose IV medications to restore adequate pressure. To activate the shock process, the referring physician calls the Froedtert & MCW Access Center.

“That shock call is routed quickly to the physician on call from critical care anesthesia who gathers facts about the patient,” Dr. Saltzberg said. The Access Center then pages a group of specialists who respond to every shock call, including members of cardiac surgery, perfusion, interventional cardiology, critical care, anesthesia and advanced heart failure, with other specialists as needed.

Within minutes, the team dials in to a conference call to discuss the patient’s needs, with each specialist weighing in to determine the best treatment. In most cases, the team will arrange to transport the patient to Froedtert Hospital for care.

“Of all the organizations I’ve been with, this is by far the most coordinated effort I’ve seen to handle these critically ill patients,” Dr. Saltzberg said.

Treatment

Treatments may include a range of circulatory support devices, such as the Impella®, placed through the skin into the heart via surgery or in the catheterization lab. “It can generate up to five liters of blood flow per minute, which is typically more than enough to sustain someone whose heart output is too low,” Dr. Saltzberg said.

Patients who need more robust support may be treated with an Extracorporeal Membrane Oxygenation system (ECMO), which pumps and oxygenates blood outside the body temporarily so the heart and lungs can rest.

The ECMO program at Froedtert Hospital is the only adult program in Wisconsin designated as a Center on Path to Excellence in Life Support by the Extracorporeal Life Support Organization. Froedtert Hospital achieved the silver level designation the first year it applied.

Improved Chance of Survival

Nationally, patient survival rates for cardiogenic shock have improved, ranging from 55-69% in recently published studies, but the cardiogenic shock process at Froedtert Hospital has shown even further improvement in outcomes.

“With the implementation of the cardiogenic shock process at Froedtert Hospital, we are now achieving survival rates of 76%,” Dr. Saltzberg said. “We’re helping more patients recover and get the therapies they need.”

“It is a really remarkable process,” Dr. Saltzberg said. “It draws on the expertise of a full team of cardiac specialists for better outcomes.”

To improve a patient’s chances of survival, Dr. Saltzberg advises referring physicians to make shock calls early.

“Our data shows that a systolic blood pressure of 90 mmHg or less, and any evidence that the patient is not generating the blood flow needed to maintain the function of vital organs, should lead to an early shock activation,” he said. “Do not wait in those cases. Early activation leads to the best possible outcomes.”

For Our Referring Physicians:

Academic advantage of cardiogenic shock specialists

The Froedtert & MCW health network gives patients and their referring physicians a distinct advantage.

To refer a patient and initiate the shock process at Froedtert Hospital, call the Access Center at 414-805-4700. Contact our physician liaison team for more information about our cardiogenic shock treatments or if you would be interested in meeting with any of the cardiogenic shock team members.

 

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