DETROIT CARDIOGENIC SHOCK INITIATIVE ALGORITHM INCLUSION CRITERIA Acute Myocardial Infarction Ischemic Symptoms EKG and/or biomarker evidence of AMI (STEMI or NSTEMI) Cardiogenic Shock Hypotension (<90/60) or the need for vasopressors or inotropes to maintain systolic blood pressure >90 Evidence of end organ hypoperfusion (cool extremities, oliguria, lactic acidosis) ACTIVATE CATH LAB ACCESS & SUPPORT Obtain femoral arterial access (via direct visualization with use of ultrasound and fluoroscopy) Obtain venous access (Femoral or Internal Jugular) Obtain either Fick calculated cardiac index or LVEDP IF LVEDP >15 or Cardiac Index < 2.2 AND anatomy suitable, place IMPELLA Coronary Angiography & PCI Attempt to provide TIMI III flow in all major epicardial vessels other than CTO If unable to obtain TIMI III flow, consider administration of intra-coronary vasodilators #Detroit #Cardiogenic #Shock #Algorithm #DCSI #Initiative #Management #Cardiology
