AMI Cardiogenic Shock Algorithm From Texas Health Presbyterian Hospital Dallas
Presenter
James B. Park, M.D., Texas Health Presbyterian Hospital Dallas, Dallas, TX
James B. Park, M.D., Texas Health Presbyterian Hospital Dallas, Dallas, TX
Title:
The OOHCA STEMI: Success Story of an NCSI Hospital
Introduction:
41 M presents with STEMI/OOHCA to a STEMI referring facility. A rapid STEMI transfer process is utilized. Cardiac cath revealed multi-vessel disease in setting of cardiogenic shock. NCSI algorithm was followed. Patient had complete neurologic recovery and was discharged home after 6.5 days.
Clinical Case:
41 M presented to STEMI referring facility with witnessed arrest, CPR total on scene was 50 minutes. Thirteen shocks for VF/VT were administered en route. In OSH, brief CPR is required and three more shocks for VF/VT. Due to weather, air transport is not available, patient receives TNK and is ground transferred.Cardiac cath revealed an occluded RCA, Circumflex and 90% LAD lesion in setting of cardiogenic shock. Impella pre-PCI and three vessel PCI completed with calculated CPO and PAPI 0.76 and 0.68 respectively post cath with Impella CP and minimal pressors. Therapeutic hypothermia was not initiated due to observed neurologic function. Over the next 48 hours, his CPO increased to 1.26 from 0.76, PAPI from 0.65 to 1.54, and Creatinine decreased from 1.72 to 0.91. Vasopressors were off at the 33 hour mark, extubation occurred at 52 hour mark and Impella explanted at 57 hours. Patient had an unknown baseline EF and TTE revealed EF of 15-20%. He was discharged home 6.5 days later with a LifeVest and close follow up.
Discussion:
NCSI algorithm set the stage for success in a critical patient and helped standardize care for cardiogenic shock patients eliminating individual provider variables.