William O’Neill: Where Are We Now After Danger Shock?

William O’Neill, M.D., provides his perspective on the implementation of the findings from the DanGer Shock randomized controlled trial (RCT) showing a mortality benefit of Impella in acute myocardial infarction cardiogenic shock (AMICS). Dr. O’Neill is the emeritus director of the structural heart program at Henry Ford Hospital, in Detroit, Michigan. He is a major innovator in medical devices, as well as one of the early users of primary percutaneous coronary intervention (PCI) and the first user of Impella in North America.

“If you have a STEMI anywhere in America,” Dr. O’Neill tells interviewer Seth Bilazarian, MD, “you’re going to get about the same approach: you’re going to get rapid transfer to the cath lab, a primary PCI, and you’re going to do very well. The same is not true with shock.” Dr. O’Neill highlights that patients with cardiogenic shock are “a very very difficult population of patients to do randomized trials. And we’ve been trying to do it for 20 years.” However, over the past decade, the best practices for the use of Impella in cardiogenic shock have been demonstrated. “And now Dr. Møller and his associates have proven in a randomized way that you save lives.”

With DanGer Shock as a “fundamental stepping stone,” Dr. O’Neill explains, “I think the next steps are going to be to try to improve the practices, improve the procedural safety, improve the results.” When asked what might move hospitals to implement the findings from DanGer Shock, Dr. O’Neill responds, “It’ll be medical leadership... They’ve got excellent randomized trial data now to show that scientifically you can save lives, and when you’re talking to administrators about doing this to save lives, I mean, they listen.”

Dr. O’Neill also explains that around the country hospitals are already seeing the benefits of the practices implemented in the DanGer Shock RCT. Hospitals with 40-50% survival put these practices in place and generally see survival improve to 70-80%. In addition, Dr. O’Neill emphasizes the importance of guidelines in moving the field forward.