Why the study?
Cardiogenic shock complicates 5%-15% of AMI cases with over 40% inpatient mortality, and standardised protocols may improve clinical outcomes in AMI-CS.
Does the implementation of a facility-based STEMI shock team management algorithm (the Durango model) enable feasible early identification, mechanical circulatory support, and primary reperfusion therapy in adults presenting with STEMI and cardiogenic shock at a rural level II medical centre?
Does the implementation of a facility-based STEMI shock team management algorithm (the Durango model) enable feasible early identification, mechanical circulatory support, and primary reperfusion therapy in adults presenting with STEMI and cardiogenic shock at a rural level II medical centre?
This prospective registry protocol outlines the Durango model to evaluate the feasibility of implementing a multidisciplinary shock team and early mechanical circulatory support algorithm for STEMI complicated by cardiogenic shock in a rural level II heart attack centre.
Answers are grounded in this paper and cite their sources.
May support shock-team protocols in rural STEMI-CS; leaves open whether standardized care improves survival in prospective registries.
INTRODUCTION: Cardiogenic shock (CS) complicates 5%-15% of cases of acute myocardial infarction (AMI) with inpatient mortality greater than 40%. The implementation of standardised protocols may improve clinical outcomes in patients with AMI-CS. METHODS AND ANALYSIS: The Durango model is a prospective single-centre registry designed to enable early identification of patients with STEMI-CS to facilitate primary reperfusion therapy with a shock team management algorithm in a rural level II heart attack centre. This prospective registry includes all patients >18 years of age presenting with STEMI with or without CS beginning on 1 February 2023. The primary outcome measures are adherence to model-based documentation of SCAI shock Classification prehospital and in the ED with appropriate STEMI shock alert for AMI and stages C, D, E shock; use of mechanical circulatory support Pre-PCI and door to support time <90 min. ETHICS AND DISSEMINATION: This study was approved by the Institutional Review Board with a waiver of informed consent. The findings will be submitted for publication in a peer-review open access journal on completion of the study. CONCLUSIONS: The Durango model will demonstrate that the implementation of a STEMI shock team can be feasible in a rural medical centre through comprehensive education of a diverse group providers with different levels of experience, continuous model/device proficiency training and performance feedback.
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Carter et al. (2023) studied this question.
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