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 



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