VCSQI-VHAC Shock Survey

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* 1. Contact Info

Name *

Organization *

Email Address *

Phone Number

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* 2. Does your organization have a shock management protocol?

Yes

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* 3. ) Does your institution have a dedicated shock team?

Yes

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* 4. Is your shock team available on a 24-7 basis?

Yes

We don’t have a Shock Team

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* 5. Does your institution have a call line for cardiogenic shock management?

Yes

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?

Yes

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* 7. Does your institution provide destination advanced heart failure services?

Yes – BTT or DT LVAD only

Yes – LVAD and transplant

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* 8. Please choose the category which would best describe your institution’s shock classification in a regionalized shock network:

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?

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?

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).

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* 11. Does your institution use any risk scores or staging systems in the stratification of patients with cardiogenic shock?

Yes