Building a Protected PCI Program: How BUMC Phoenix Is Enhancing Revascularization Outcomes One Patient Transfer at a Time

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 - BUMC Phoenix PCI

To make a difference in people’s lives through excellent patient care is both mission and mantra at Banner Health. The interventional cardiology team at Banner University Medical Center Phoenix is focused on effectively escalating patient care as the primary referral site for high-risk and emergent patients in need of revascularization—specifically those with acute MI in cardiogenic shock—across the network of hospitals. A transfer is just a phone call away. Take a closer look at how BUMC Phoenix’s successful Protected PCI program is improving and saving patient lives.

Hear more from the team at BUMC Phoenix, watch Episode 5: Enhancing Revascularization Outcomes One Patient Transfer at a Time from the series, Building a Protected PCI Program.

By the numbers, Banner Health is among the top 10 largest nonprofit hospital systems in the country. BUMC Phoenix is part of the health system that operates 29 hospitals, including three academic medical centers, and other related health entities and services in Alaska, Arizona, California, Colorado, Nebraska, Nevada and Wyoming. Banner has evolved from a health system of hospitals into a fully integrated system that includes expanded services through Banner Health Network; Banner Medical Group; and Banner University Medicine, the academic medicine division of Banner Health that merged with the University of Arizona College of Medicine and is anchored in Phoenix and Tucson.

“Ultimately both as physicians and as a hospital, our primary goal is to provide care to the patients we serve,” says Ashish Pershad, MD, the interventional cardiologist who leads the system’s complex PCI program. “That mission embodies the way Banner and physicians working at our medical center think.”

BUMC Phoenix links academic medicine with community care, serving as the go-to facility for patients needing elevation of care, such as a patient on ECMO or a patient who needs an LVAD. Patients transferred to BUMC Phoenix come from throughout the Southwest. About 30 to 40 percent are transferred from community hospitals surrounding Phoenix, while some 20 to 30 percent are referred from county or VA medical centers. Another 10 to 20 percent arrive from the indigent population living near the medical center. Many are post-MI cardiogenic shock patients or those with post-infarct mechanical complications, and many need left ventricular support.

“It’s the [patients who] either are spiraling in spite of treatment or are just too sick to get better,” Pershad says. “Those are the ones who end up coming our way. Most patients are in cardiogenic shock in the setting of either an acute MI or just shock in general, either due to an acute MI or due to a fulminant process like myocarditis or pericarditis, or from valvular disease.”

Most patients arrive already on some form of hemodynamic support, usually in need of either support of a higher magnitude or revascularization. The patients are often older and vulnerable. “So the thought is to regionalize the care so that these high-end procedures are performed at centers that have the most experience so that they can be done thoughtfully and with an eye on cost containment and best practices,” Pershad says.

“The beauty of the Banner system is that it has that capacity,” echoes H. Kenith Fang, MD, chief of cardiothoracic surgery. “Any Banner facility that has a cardiothoracic problem in their emergency room or as an inpatient has access to cardiovascular care.”

Expanding Protected PCI

The interventional team at BUMC Phoenix treats patients in its six cardiac cath labs, two electrophysiology labs, four coronary and peripheral labs and two hybrid ORs. For complex and high-risk PCIs, the team often relies on the Abiomed’s Impella family of left-heart pumps. This spring, the FDA cleared the family of left-heart pumps for treating acute MI patients with cardiogenic shock—which expands the treatment options for 5 to 8 percent of the patients who arrive in Banner’s ER.

The expanded approval allows the use of the left-heart pumps to help stabilize the shock patient’s hemodynamics, unload the left ventricle, perfuse the end organs and rest the heart enough to, ideally, recover full function. The left-heart pumps are the  first and only percutaneous temporary ventricular support devices deemed safe and effective for the cardiogenic shock. According to the new labeling: The Impella 2.5, Impella CP, Impella 5.0 and Impella LD catheters, in conjunction with the Automated Impella Controller