Alex Truesdell: Creating Successful Cardiogenic Shock Teams Post DanGer Shock

Alexander Truesdell, M.D., discusses factors involved in creating successful cardiogenic shock teams following the results of the DanGer Shock randomized controlled trial (RCT) demonstrating a statistically significant mortality benefit of Impella use in acute myocardial infarction cardiogenic shock (AMICS). Dr. Truesdell is an interventional cardiologist at Inova Schar Heart and Vascular in Virginia.

Interviewer Seth Bilazarian, MD, notes that an impediment to developing shock programs in the past has been concerns that there was not adequate data. He asks Dr. Truesdell what hurdles remain to the implementation of cardiogenic shock programs.

After commending the DanGer Shock trial team for providing “really high quality randomized controlled data,” Dr. Truesdell highlights the importance of also having best practices, including practices for device management and anticoagulation, as well as iterative technologic changes for the device. “I don’t think this happens without all three, but the linchpin and the underpinning has to be this randomized data. And so, I think it's really exciting to have proof of what many of us were fairly certain we knew, but couldn’t prove definitively.”

Dr. Bilazarian asks how to get all physicians on a STEMI team to be comfortable using Impella so that all patients have an opportunity for this lifesaving technology. “It’s an iterative process,” Dr. Truesdell explains. Some physicians now have the randomized data they need, but others are concerned about complications; however, he emphasizes, “a mortality benefit trumps all the other things.”

Dr. Truesdell explains that after-action or quality reviews of cases are an essential component in developing a shock program. It is important, he emphasizes, to acknowledge the successes that you want to continue and identify opportunities for improvement. He highlights the importance of gaining multidisciplinary buy-in from nursing, heart failure, critical care, cardiology, interventional cardiology and cardiac surgery. This helps get everyone invested in working together, and all of this, he concludes, helps develop and reinforce best practices in managing cardiogenic shock.