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VCSQI-VHAC Shock Survey 2024
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1.
Contact Info
(Required.)
Name
*
Organization
*
Email Address
*
Phone Number
*
2.
Does your organization have a shock management protocol?
(Required.)
Yes
No
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3.
) Does your institution have a dedicated shock team?
(Required.)
Yes
No
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4.
Is your shock team available on a 24-7 basis?
(Required.)
Yes
No
We don’t have a Shock Team
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5.
Does your institution have a call line for cardiogenic shock management?
(Required.)
Yes
No
We don’t have a Shock Team
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6.
Does your institution have a 24-7 capable cardiac cath lab with primary PCI capability?
(Required.)
Yes
No
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7.
Does your institution provide destination advanced heart failure services?
(Required.)
Yes – Bridge to Transplant (BTT) or Destination Therapy (DT) LVAD only
Yes – LVAD and transplant
No
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8.
Please choose the category which would best describe your institution’s shock classification in a regionalized shock network:
(Required.)
Level 1 Shock center: LVAD/transplant, High Risk PCI, ECMO and Impella capabilities.
Level 2 Shock Center –24/7 cardiac cath lab with primary PCI and IABP capability. May be able to implant Impella and ECMO on site but would transfer to Level 1 center for LVAD and/or transplant evaluation if destination therapies needed.
Level 3 Shock Center – Non-PCI capable with primary referrals to Level 1 and Level 2 centers.
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9.
Which of the following best describes your practice with regards to utilizing pulmonary arterial catheters to diagnose cardiogenic shock?
(Required.)
Almost always (>80% of cases)
Most Times (60-80% of cases)
Sometimes (40-60% of cases)
Rarely (20-40% of cases)
Almost Never (<20% of cases).
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10.
Which of the following best describes your practice with utilizing pulmonary arterial catheters to manage cardiogenic shock patients with mechanical circulatory support?
(Required.)
Almost always (>80% of cases)
Most Time (60-80% of cases)
Sometimes (40-60% of cases)
Rarely (20-40% of cases)
Almost never (<20% of cases).
*
11.
Does your institution use any risk scores or staging systems in the stratification of patients with cardiogenic shock?
(Required.)
Yes
No
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