Ep. 2 Cardiogenic Shock Management: Latest Strategies and Innovations with Dr. Amir Kaki

In 2024, the DanGer Shock trial changed cardiogenic shock guidelines and affected practice patterns internationally. This episode of the BackTable Cardiology Podcast explores tips, tricks, and best practices in utilizing Impella, ECMO, and national initiatives to most effectively treat patients with cardiogenic shock. Host Dr. Sameh Sayfo interviews Dr. Amir Kaki, a noted interventional cardiologist and Director of Mechanical Circulatory Support and Complex PCI at Henry Ford St. John Hospital in Detroit.

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SYNPOSIS

The discussion centers on the advances in mechanical circulatory support devices like Impella and ECMO, their history, usage criteria, and impact on patient outcomes. Dr. Kaki details the landmark Detroit Cardiogenic Shock Initiative, the challenges surrounding ECMO use, and the critical implementation of the recent DanGer-SHOCK Trial in clinical practice. After outlining the history of interventions for cardiogenic shock and the significance of recent trials within the field, he emphasizes the necessity for contemporary cardiologists to be skilled in endovascular techniques.

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TIMESTAMPS

00:00 - Introduction
02:12 - National Cardiogenic Shock Initiative
06:23 - Shock 2 Trial
07:48 - ECLS-SHOCK Trial and ECMO
15:05 - DanGer Trial
22:56 - Parameters for Impella RP vs Impella CP Use in Cardiogenic Shock
29:39 - Impella Considerations: Placement, Limb Ischemia, Removal
37:56 - Modern Cardiogenic Shock: Overview and Resources
40:16 - Conclusion

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RESOURCES

The National Cardiogenic Shock Initiative:
https://www.ahajournals.org/doi/10.1161/JAHA.123.031401

DanGer Shock Trial:
https://www.acc.org/Latest-in-Cardiology/Clinical-Trials/2024/04/05/04/44/danger-shock

Large-Bore Access Site Management
https://assets.bmctoday.net/citoday/pdfs/cit0719_SF2_Kaki.pdf

Short-Term Mechanical Circulatory Support for Cardiogenic Shock
https://scai.org/publications/ebooks/short-term-mechanical-circulatory-support-cardiogenic-shock

Intraaortic Balloon Support for Myocardial Infarction with Cardiogenic Shock
https://www.nejm.org/doi/full/10.1056/NEJMoa1208410

Extracorporeal Life Support in Infarct-Related Cardiogenic Shock
https://www.nejm.org/doi/full/10.1056/NEJMoa2307227

Dr. Amir Kaki, MD
https://www.heartteam.com/provider/amir-kaki-md
https://scai.org/about-us/scai-staff-listing/amir-kaki-md-fscai

Dr. Sameh Sayfo
https://www.bswhealth.com/physician/sameh-sayfo