Utilization of Shock Team and Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) in the Management Cardiogenic Shock in North Ontario

BACKGROUNDDespite advancements in critical care and coronary revascularization, cardiogenic shock (CS) outcomes remain poor. Implementing a shock team and VA-ECMO utilization have been associated with improved CS outcomes, but their feasibility in remote and rural areas remains unknown.METHODThis retrospective study included patients with CS who required mechanical circulatory support (MCS) at Health Sciences North, Sudbury, Ontario. The analysis aimed to accomplish two objectives: firstly, to review the outcomes associated with Impella® usage, and secondly, to assess the feasibility of establishing a shock team to facilitate the local implementation of VA-ECMO. The primary endpoint was in-hospital mortality.RESULTSThe outcomes of 15 CS patients who received Impella® between 2015-2021 were reviewed. Their average age was 65 years (SD,13), and 8 patients (53%) were female. CS was ischemic in 12 patients (80%). Transfemoral Impella® CP (cardiac power) was the most frequently used (93%). Thirteen patients (87%) died during the index hospital stay post-Impella® due to progressive circulatory failure. The shock team was established following consultations with several Canadian MCS centres, leading to the development of a protocol to guide MCS utilization. There have been four cases where percutaneous VA-ECMO using Cardiohelpâ has been utilized; three (75%) survived beyond the index hospitalization.CONCLUSIONSThis analysis demonstrated the feasibility of implementing a shock team in remote Northern-Ontario, enabling the use of VA-ECMO with success in a centre with a sizeable rural catchment area. This initiative helps address the gap in cardiac care outcomes between rural and urban areas in Ontario. Despite advancements in critical care and coronary revascularization, cardiogenic shock (CS) outcomes remain poor. Implementing a shock team and VA-ECMO utilization have been associated with improved CS outcomes, but their feasibility in remote and rural areas remains unknown. This retrospective study included patients with CS who required mechanical circulatory support (MCS) at Health Sciences North, Sudbury, Ontario. The analysis aimed to accomplish two objectives: firstly, to review the outcomes associated with Impella® usage, and secondly, to assess the feasibility of establishing a shock team to facilitate the local implementation of VA-ECMO. The primary endpoint was in-hospital mortality. The outcomes of 15 CS patients who received Impella® between 2015-2021 were reviewed. Their average age was 65 years (SD,13), and 8 patients (53%) were female. CS was ischemic in 12 patients (80%). Transfemoral Impella® CP (cardiac power) was the most frequently used (93%). Thirteen patients (87%) died during the index hospital stay post-Impella® due to progressive circulatory failure. The shock team was established following consultations with several Canadian MCS centres, leading to the development of a protocol to guide MCS utilization. There have been four cases where percutaneous VA-ECMO using Cardiohelpâ has been utilized; three (75%) survived beyond the index hospitalization. This analysis demonstrated the feasibility of implementing a shock team in remote Northern-Ontario, enabling the use of VA-ECMO with success in a centre with a sizeable rural catchment area. This initiative helps address the gap in cardiac care outcomes between rural and urban areas in Ontario.