Researchers find significant differences in care of life threatening shock after heart attack

In recent years, the microaxial flow pump has gained popularity as a treatment for STEMI-related cardiogenic shock, particularly considering data published in The New England Journal of Medicine in 2024 which showed that the heart pump treatment reduced mortality by over 26%.

However, one-quarter of the patients treated with the microaxial flow pump had device-related complications, such as bleeding, kidney injury and infections.

In the Michigan study, fewer than one-quarter of all patients were treated with the microaxial flow pump. Throughout 50 centers in the state of Michigan, there was significant variation in the type of treatment offered to these critically ill patients.

“This points to the main issue that in Michigan hospitals, and likely across the country, the volume of acute myocardial infarction cardiogenic shock is typically low,” Cantey said.

“Because of this, it is difficult for all team members to feel comfortable with all the facets of AMI-CS care — including early detection of cardiogenic shock, stratifying risk, determining proper treatment plans and managing postoperative ICU care to decrease the risk of device complications.”

Need for best practices, adoption

The Michigan Medicine-led group concluded that establishing and implementing shock protocols may help institutions with fewer resources optimize how they manage the condition.

“It is critical that this is not a one size fits all model, but it is equally important that certain best practices for the multiple stages of cardiogenic shock care — such as early detection, prompt revascularization and support, and proactive intensive unit care — are followed.”

For example, fewer than one-third of the study’s patients received a right heart catheterization. This procedure tests the pressures within the heart and is critical for the risk stratification and management of cardiogenic shock in the cardiac intensive care unit.

The findings also speak to the need to potentially centralize cardiogenic shock care, Hamilton says.

“There is potential to create hub and spoke models, in which catheterization labs could transfer patients to centers with expertise in the critical management of STEMI-related cardiogenic shock and use of devices like the microaxial flow pump,” he said.

“Each institution will need a process to ensure its providers are confident and capable of treating with a microaxial flow pump and other available shock devices.”

Now that there is a device that improves outcomes in select patients with cardiogenic shock, researchers say, it is time to think about real-world implementation to improve patient outcomes and safety.

“While there is a lot of work to be done, we believe that our analysis will set the groundwork for future efforts to further move the needle of survival in this critically ill population,” said Hitinder Gurm, MBBS, senior author and chief medical officer at U-M Health.

“The stakes are incredibly high in this sick population, but the potential to further lower the incredibly high mortality rate is what keeps us motivated.”

Additional authors: Aaron Lopacinski, M.D., Elias J. Dayoub, M.D., both of University of Michigan, Siddharth Gandhi, D.O., of McLaren Northern Michigan, Mir B. Basir, D.O., of Henry Ford Health Care System, Amir Kaki, M.D., Henry Ford-St. John Hospital, Ryan D. Madder, M.D., Devraj Sukul, M.D., both of Frederik Meijer Heart and Vascular Institute, and Milan Seth, M.S., of Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2).

Funding/disclosures:  Support for BMC2 is provided by Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network as part of the BCBSM Value Partnerships program. Although BCBSM and BMC2 work collaboratively, the opinions, beliefs and viewpoints expressed by the authors do not necessarily reflect the opinions, beliefs, and viewpoints of BCBSM or any of its employees.

Basir has served as a consultant for Abiomed. Kaki has received speaker honoraria from and has served as a consultant to Abiomed.

Paper cited: “Managing Cardiogenic Shock Caused by Acute Myocardial Infarction: Invisible Challenges Revealed in a Statewide Registry,” The Journal of the American College of Cardiology. DOI: 10.1016/j.jacc.2025.02.027

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