Detroit Cardiogenic Shock Initiative Theodore L Schreiber MD

Detroit Cardiogenic Shock Initiative Theodore L. Schreiber, MD, FACC, FASCI, FCCP President, Detroit Medical Center Heart Hospital

Disclosure Statement of Financial Interest I, Theodore L. Schreiber, MD, DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation.

DETROIT CARDIOGENIC SHOCK INITIATIVE DETROIT CSI 3

4 CARDIOGENIC SHOCK A CHANGE IN PARADIGM DOOR TO BALLOON DOOR TO SUPPORT

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CSI DETROIT – QUALITY MEASURES 6

CSI DETROIT – INCLUSION AND EXCLUSION CRITERIA 7

CSI DETROIT TREATMENT ALGORITHM 8

CSI DETROIT TREATMENT ALGORITHM – HEMODYMANICS AND ESCALATION 9

CSI DETROIT TREATMENT ALGORITHM – WEANING OR ESCALATION 10

RESULTS OF PILOT STUDY • July, 2016 – January, 2017 • N = 30 • Sites: – St Joseph's (Pontiac) (N=10) – Beaumont Royal Oak & Troy (N=9) – Henry Ford (N=6) – Detroit Medical Center (N=5) • Demographics – Age 63 +/- 13 years (36 -87) – 80% Male, 20% Female – Diabetics 48% 11

HEMODYNAMICS • SBP 79. 6 • DBP 53. 7 • MAP 61. 1 • Lactate – Median 4. 2 – Average 4. 6 – Range 1. 5 - 16 Pre-Impella No Pressors/Inotr opes 20% 12 Support Pressors and IABP 10% IABP 3% Pressors 67%

PRE-PROCEDURAL CHARACTERISTICS • Transfer from outside hospital 31% (N=9/29) – 4 patient transported with IABP • 26% (N=8/30) In Hospital Cardiac Arrest • 23% (N=7/30) Required CPR • 67% presented to hospital in shock (N=19/28) 13

PROCEDURAL CHARACTERISTICS • 4 patients under active CPR at the time of Impella implantation – 75% survival (N=3/4) • Duration of Shock (N=20) – 58 mins (20 - 229 minutes) • Door to Balloon Time (N=16) – 64 minutes • AMI to Shock Time (N=13) – 93 minutes • Shock to Device Time (N=23) – 64. 6 minutes (8 -229) • Impella Timing (N=29) – Pre. PCI 65% – Post. PCI 28% – Intraprocedure 7% • Impella Type (N=29) – CP 97% – RP 3% • 100% Femoral Access 14

PROCEDURAL CHARACTERISTICS • 100% successful PCI • Pre Procedure TIMI Score – 74% TIMI 0 (n=27) • Post Procedure TIMI Score (n=27) – 81% TIMI 3 • 55 % thrombectomy (n=16/29) • 82% RHC use (n=12/28) 15

OUTCOMES • Cardiac Power – 0. 59 (Pre) (n=14) – 0. 71 (Post) (n=20) • Procedural Survival 93 % (N=28/30) • Survival to Discharge 80% (N=24/30) 16

17 Thank you!