Northwest Medical Center-Springdale participating in National Cardiogenic Shock Initiative
3/22/2019
Dr. Michael Green is lead investigator
Northwest Medical Center-Springdale was one of the first 50 hospitals nationwide participating in a new study to identify the best treatment for people who experience cardiogenic shock following a heart attack (AMI-CS). Called the National Cardiogenic Shock Initiative (NCSI), it is a multicenter study designed to assess the feasibility of whether outcomes in cardiogenic shock can be improved by using standardized best practices including inserting a special heart pump to protect the patient during a percutaneous coronary intervention.
Cardiogenic shock (CS) is a medical emergency during which the heart suddenly can't pump enough blood to meet the body's needs. During a heart attack, cardiogenic shock is a complication that occurs less than 10% of the time, but when it does, only 30% of those patients with this profound shock survive.
Northwest Health Interventional Cardiologist Dr. Michael Green is the lead investigator locally. “This is a very significant study that we believe will lead to the identification of the best practices for treatment that will save lives,” he said. “Approximately 8% of patients who suffer an acute heart attack each year will develop cardiogenic shock. That’s about 60,000 people.”
Partnering hospital systems in the NCSI study use a defined protocol for treatment of AMI patients in cardiogenic shock which includes quick placement of the heart pump, PCI, and right heart monitoring to rapidly reduce the use of inotropes. Quality data is collected on each patient. The initial pilot study has shown improvement in survival rates from 30% to 76%.
“In recent years, we have seen impressive gains with a 21% mortality reduction in ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI). However, acute myocardial infarction complicated by cardiogenic shock (AMI-CS) has not seen similar successes and continues to have a high mortality, near 50%. Recent trials have not clarified the best strategies in treatment,” Dr. Green said. “In the NCSI study, investigators have suggested processes of care with a treatment pathway for patients with acute myocardial infarction complicated by cardiogenic shock.”
The study was first conceived shortly after a new device was approved in April 2016 by the U.S. Food and Drug Administration – a percutaneous transvalvular continuous-flow microaxial MCS device for use in AMI-CS. It is believed this device – and others like it introduced since that time – may have a major role in the care of patients with AMI-CS just as PCI had for STEMI. The National Cardiogenic Shock Initiative (NCSI) provides an algorithm to maintain consistency and reproducibility that may provide insights into the best practices associated with the use of such devices.
The care of patients with AMI-CS is a national issue, declared as a priority by the Institute of Medicine. Historically, recruitment in clinical trials of CS has been difficult, with a low number of enrollees preventing implementation of evidence-based therapies.
Partnering hospital systems in the NCSI study – like both Northwest Medical Center-Springdale and Northwest Medical Center-Bentonville – now use this defined protocol for treatment of AMI-CS patients. This includes quick placement of the heart pump, PCI to open the blocked vessel(s), and right heart monitoring to rapidly reduce the use of inotropes, medications that affect the contraction of the heart muscle. Thanks to these new processes and fast action by the experienced staff, more lives are being saved.
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