Cardiogenic Shock Management

Mortality rates for cardiogenic shock (CS) remain high, but the development of percutaneous left ventricular assist devices and the adoption of a shock-team approach, which emphasizes early use of mechanical circulatory support (MCS) devices and hemodynamic monitoring, has been shown to improve outcomes. The introduction of the Impella CP and Impella 5.5 has expanded options for left ventricular temporary MCS. This case series highlights our experience managing patients with CS using a shock protocol escalation strategy from Impella CP to Impella 5.5. Notably, all cases reflect the decision-making process of transitioning to a different MCS modality quickly based on real-time hemodynamic data. We believe our shock protocol can be easily adapted by most US hospitals with cardiac catheterization laboratories and can be replicated in most settings with minimal adjustments.