Standardized protocols to guide early intervention with mechanical circulatory support (MCS) in the most severe stages of cardiogenic shock can improve outcomes, according to new results from the CERAMICS trial.

The results reinforce the importance of early recognition and protocol-driven care in improving patient survival, said Babar Basir, DO, interventional cardiologist and medical director of the Acute MCS Program at Henry Ford Health in Detroit.

Basir presented the results of the CERAMICS trial at the Society for Cardiovascular Angiography and Intervention (SCAI) 2026 in Montreal.

A Survival Benefit

The trial focused on the CERAMICS registry, the third iteration of the Cardiogenic Shock Initiative, which is itself a follow-up to the Detroit Cardiogenic Shock Initiative and National Cardiogenic Shock Initiative (NCSI). Those previous studies included some hospitals with limited ICU and escalation capabilities, whereas CERAMICS included only sites with MCS escalation capabilities with devices such as Impella 5.5 (Johnson & Johnson [J&J] MedTech) and extracorporeal membrane oxygenation.

CERAMICS enrolled 124 patients at 20 hospitals. They were initially treated using a shock protocol emphasizing rapid placement of Impella, percutaneous coronary intervention, and invasive monitoring of hemodynamics. Patients in CERAMICS were older than those in NCSI, were more likely to present in stage E shock, and were more likely to undergo MCS escalation (22% vs 10%; P = .05).

For patients in stage C or D shock, outcomes were similar between CERAMICS and NCSI, with survival rates of 79% in NCSI and 75% in CERAMICS — a difference that was not statistically significant. But patients who presented in stage E had a 17% improvement in mortality, from 50% to 67%, when treated in a facility with MCS escalation capabilities.

Clinical Implications

Walter Schiffer, MD, cardiologist at Washington University School of Medicine in St. Louis, said the study highlights the benefits of treating the most severe cases at centers with MCS escalation capability.

The results reinforce the importance of early hemodynamic characterization, systematic MCS support, and ongoing trajectory assessment to guide targeted escalation in cardiogenic shock after an acute MI, said Schiffer, who was not involved in the study. The findings also highlight the need to develop regionalized shock networks that can triage the sickest patients to centers with advanced MCS escalation, he said.

J. Dawn Abbott, MD, interventional cardiologist at Brown University Health Cardiovascular Institute, Providence, Rhode Island, and SCAI president, said the results show the benefits of current clinical practices.

“Only a small minority of the patients received escalation with a device, which suggests that our current therapies and algorithms are working quite well,” said Abbott, who was not involved in the study. “But something that we can learn is whether there are barriers to device escalation that were not captured in the study.”

Those barriers could include whether physicians felt the patient wasn’t suitable because of anatomic characteristics such as small blood vessels or other comorbidities possibly limiting survival, she said.

Basir reported receiving research support from J&J MedTech (Abiomed) and being a consultant for Boston Scientific, Chiesi Farmaceutici, J&J MedTech (Abiomed), and ZOLL. Schiffer reported being on the Etiometry advisory board and receiving funding from Abiomed and J&J MedTech for research in collaboration with Etiometry. Abbott reported having no relevant financial relationships.

Brian Owens is a freelance journalist based in New Brunswick, Canada.