New Mexico landscape at golden hour with a road connecting remote communities

New Mexico Cardiogenic Shock Network

No one should die
of geography.

A statewide system of care ensuring every New Mexican in cardiogenic shock has equal access to life-saving treatment — regardless of which emergency room they enter.

Start here — how can we help? ↓ Partner With Us Learn Our Mission
37.6% → 59.4% Single-Center 30-Day Survival, Before → After
313 Patients, Pre/Post Study
33 Counties Served
Suspected cardiogenic shock? Level 1 Hub Transfer · 1-888-727-7646 Call early — you do not need a confirmed diagnosis to activate. Currently routes to Heart Hospital of New Mexico. UNM coming soon.

Start here

How can we help?

NMCSN is built to guide anyone touched by cardiogenic shock — comprehensive care, from first suspicion to recovery.

Pick one to get started.

Our Mission

To save lives by ensuring everyone with cardiogenic shock has equal access to expert care.

No matter where they live or receive care in New Mexico and the surrounding region, every patient deserves the same chance to survive cardiogenic shock.

We coordinate rapid identification, stabilization, and transfer through standardized protocols, AI-enabled tools, and a hub-and-spoke network linking rural hospitals and EMS to high-capability shock centers.

Build cardiac trauma systems around people, not devices.

Identify

Early recognition through standardized triage protocols and hemo-metabolic triggers at every ER in the state.

Transfer

Coordinated transport pathways connecting spoke hospitals to hub shock centers with one-call activation.

Treat

Evidence-based care with mechanical circulatory support, hemodynamic monitoring, and shock team protocols.

Cardiogenic Shock Care Models: A Paradigm Shift — From technology-centered to patient-centered shock systems. Build cardiac trauma systems around people, not devices.

The Problem

Cardiogenic shock is the deadliest cardiac emergency — and geography makes it worse.

40-50%

of patients with cardiogenic shock die despite modern therapy — 30-day mortality was 47–56% in the SHOCK trial and remained 40% in IABP-SHOCK II thirteen years later.1,2

2x

higher in-hospital mortality at hospitals without PCI capability (64.5%) than at advanced heart centers (36.5%) — in 1.17 million US shock hospitalizations. Capability, not distance, is the dividing line.3

94 mi

median transfer distance to definitive shock care in our New Mexico cohort, reaching 230 miles — distances that decide who reaches a shock team at all.4

The Solution

Coordinated shock care is associated with substantially higher survival. One program’s 30-day survival rose from 47% to 76.6% over two years after adding a multidisciplinary shock team;5 centers with shock teams report lower ICU mortality than those without (23% vs 29%);6 and a national protocol-driven initiative reported 71% survival to discharge in AMI-related shock.7 NMCSN is building this for New Mexico.

EMS · ER · Referring providers“Should this be a shock call?” — walk the activation algorithm step by step →Answer a few questions; it tells you what the algorithm concludes and why, and connects you to the shock line.New to these algorithms? Read the plain-language explainer →What each box means and why, from our Cardiac Trauma framework. Algorithm 1 is for EMS, ER & referring providers · Algorithm 2 is for the cath lab & ICU.

Our Protocols

The algorithms our shock team runs, statewide.

How cardiogenic shock is identified, called, and managed across New Mexico — shared openly so any clinician at any hospital can use them. Click a protocol to view it full size.

NMCSN Shock Team Activation Algorithm — hemo-metabolic triggers, classic or POCUS-supported CS, shock call, considerations and goals
Shock Team Activation Algorithm  ·  Version 2.0, February 2026  ·  Full resolution ↓
NMCSN Cardiogenic Shock Assessment and Management — SCAI stage B through D/E pathways, hemodynamic assessment, device escalation
CS Assessment & Management  ·  Version 2.0, February 2026  ·  Full resolution ↓
Stage a patient with the interactive staging tool →Walk the activation algorithm →

Decision support only. These protocols reflect NMCSN practice and are shared for education and program development; they do not replace your institution's protocols or clinical judgment at the bedside.

Our Results

One center’s results. The network is how we find out if they hold statewide.

These results are our own — from a pre/post study of 313 cardiogenic shock patients treated through our program in New Mexico (2019–2024), now under review at JSCAI. How the network is structured →

59.4% 30-Day Survival

Thirty-day survival rose from 37.6% to 59.4% after the NMCSN hub program launched — our own 313-patient study (p<0.001).

52.4% 1-Year Survival

One-year survival rose from 32.7% to 52.4% — the benefit persists long after the initial event.

321 mi Farthest Documented Transfer

The farthest documented transfer into the network. Post-cardiotomy shock, which falls outside the study cohort’s definition.

Zero Geographic Gap

After implementation, 30-day survival was the same for transferred and directly admitted patients (59.5% vs 59.4%) — at any transfer distance.

Our Model

The Hub-and-Spoke Imperative

One shock network. Every hospital has a role.

New Mexico’s cardiogenic shock capability isn’t distributed evenly — and it doesn’t need to be. What matters is that every hospital knows which role it’s playing today and has the tools to play it well. Heart Hospital of NM is the state’s Level 1 hub: the only dedicated cardiogenic shock program in New Mexico.

The tiers exist to make geography stop mattering. Across our first 313 patients, 30-day survival after implementation was the same whether someone was transferred in or admitted directly — 59.5% against 59.4%, at any distance. That is a pre/post comparison within one cohort, not a controlled trial, and the study is under review at JSCAI. See the results →

Level 1 · Hub

Dedicated 24/7 cardiogenic shock program. Full cath lab, advanced percutaneous and surgical mechanical circulatory support, cardiac surgery, and durable LVAD capability.

Receives transfers. Provides tele-consult. Runs the shock team.

Level 1

PCI-capable with advanced temporary mechanical circulatory support, without a dedicated 24/7 shock program or durable LVAD.

Revascularizes. Places advanced tMCS. Escalates for durable support.

Level 2 · Advanced Spoke

Cath lab, with or without temporary mechanical circulatory support.

Performs initial revascularization. Stabilizes higher-acuity patients. Transfers for advanced support when needed.

Level 3 · Stabilize + Activate

No cath lab required.

Recognize cardiogenic shock. Stabilize the patient. Activate the shock network by phone. This is where NMCSN’s staging tool and activation assistant do their work.

New Mexico cardiogenic shock capability map A map of New Mexico with the bordering regions of Arizona, Colorado, Oklahoma and Texas shown for orientation. Fifty-five hospitals are plotted at their geographic locations and colored by clinical capability tier: one Level 1 hub with a dedicated cardiogenic shock program, marked with a star in central New Mexico; two further Level 1 centers; seventeen Level 2 cath-lab centers; and thirty-five Level 3 centers without a cath lab. Apart from the hub, individual facilities are not named. ARIZONA COLORADO NEW MEXICO TEXAS OKLAHOMA role="img" aria-label="Level 3 center in southern central New Mexico">Level 3 center in southern central New Mexico role="img" aria-label="Level 3 center in central New Mexico">Level 3 center in central New Mexico role="img" aria-label="Level 3 center in central New Mexico">Level 3 center in central New Mexico role="img" aria-label="Level 3 center in central New Mexico">Level 3 center in central New Mexico role="img" aria-label="Level 3 center in southern eastern New Mexico">Level 3 center in southern eastern New Mexico role="img" aria-label="Level 3 center in northern central New Mexico">Level 3 center in northern central New Mexico role="img" aria-label="Level 3 center in southern western New Mexico">Level 3 center in southern western New Mexico role="img" aria-label="Level 3 center in central New Mexico">Level 3 center in central New Mexico role="img" aria-label="Level 3 center in central New Mexico">Level 3 center in central New Mexico role="img" aria-label="Level 3 center in central western New Mexico">Level 3 center in central western New Mexico role="img" aria-label="Level 3 center in northern western New Mexico">Level 3 center in northern western New Mexico role="img" aria-label="Level 3 center in central western New Mexico">Level 3 center in central western New Mexico role="img" aria-label="Level 3 center in central western New Mexico">Level 3 center in central western New Mexico role="img" aria-label="Level 3 center in southern eastern New Mexico">Level 3 center in southern eastern New Mexico role="img" aria-label="Level 3 center in central New Mexico">Level 3 center in central New Mexico role="img" aria-label="Level 3 center in northern eastern New Mexico">Level 3 center in northern eastern New Mexico role="img" aria-label="Level 3 center in southern central New Mexico">Level 3 center in southern central New Mexico role="img" aria-label="Level 3 center in central western New Mexico">Level 3 center in central 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center in central eastern New Mexico role="img" aria-label="Level 3 center in southern western New Mexico">Level 3 center in southern western New Mexico role="img" aria-label="Level 3 center in southern eastern New Mexico">Level 3 center in southern eastern New Mexico role="img" aria-label="Level 3 center in central New Mexico">Level 3 center in central New Mexico role="img" aria-label="Level 3 center in central eastern New Mexico">Level 3 center in central eastern New Mexico role="img" aria-label="Level 3 center in northern western New Mexico">Level 3 center in northern western New Mexico role="img" aria-label="Level 3 center in northern eastern New Mexico">Level 3 center in northern eastern New Mexico role="img" aria-label="Level 3 center in central New Mexico">Level 3 center in central New Mexico role="img" aria-label="Level 3 center in central New Mexico">Level 3 center in central New Mexico role="img" aria-label="Level 2 center in central New Mexico">Level 2 center in central New Mexico role="img" aria-label="Level 2 center in southern Colorado">Level 2 center in southern Colorado role="img" aria-label="Level 2 center in southern eastern New Mexico">Level 2 center in southern eastern New Mexico role="img" aria-label="Level 2 center in southern central New Mexico">Level 2 center in southern central New Mexico role="img" aria-label="Level 2 center in southern central New Mexico">Level 2 center in southern central New Mexico role="img" aria-label="Level 2 center in southern central New Mexico">Level 2 center in southern central New Mexico role="img" aria-label="Level 2 center in central eastern New Mexico">Level 2 center in central eastern New Mexico role="img" aria-label="Level 2 center in central New Mexico">Level 2 center in central New Mexico role="img" aria-label="Level 2 center in central New Mexico">Level 2 center in central New Mexico role="img" aria-label="Level 2 center in west Texas">Level 2 center in west Texas role="img" aria-label="Level 2 center in west Texas">Level 2 center in west Texas role="img" aria-label="Level 2 center in west Texas">Level 2 center in west Texas role="img" aria-label="Level 2 center in southern Colorado">Level 2 center in southern Colorado role="img" aria-label="Level 2 center in west Texas">Level 2 center in west Texas role="img" aria-label="Level 2 center in southern central New Mexico">Level 2 center in southern central New Mexico role="img" aria-label="Level 2 center in southern eastern New Mexico">Level 2 center in southern eastern New Mexico role="img" aria-label="Level 2 center in northern western New Mexico">Level 2 center in northern western New Mexico role="img" aria-label="Level 1 center in central New Mexico">Level 1 center in central New Mexico role="img" aria-label="Level 1 center in central New Mexico">Level 1 center in central New Mexico
Hospitals shown by clinical capability tier. Individual facilities are not named at this stage of network development. Markers in the Albuquerque metro are spread around the hub so each remains visible.

Within the study cohort, half of all transfers travelled more than 100 miles; the farthest was 230. Survival after implementation did not fall with distance.

A spoke hospital doesn’t need an interventionalist. It needs a staging tool and a phone number.
Activation Assistant → Staging Tool → Transfer Line: 1-888-727-7646 Tell us you’re in →

Transfer line currently routes to Heart Hospital of New Mexico. UNM coming soon.

AI & Innovation

Using artificial intelligence to deliver care where it's needed most.

NMCSN is pioneering the integration of AI into systems of care — not to replace clinicians, but to extend expertise across geography.

Vision

AI-Enabled Systems of Care

NMCSN is our first case example of a broader vision: AI-enabled, patient-centric systems that can deliver the right expertise, pathways, and logistics to any patient, in any setting. What we build for cardiogenic shock becomes the reusable blueprint for obstetrics, trauma, stroke, and every other time-sensitive condition.

Active

Educational Agents

AI-generated education bundles tailored to each audience — ER physicians, ICU teams, EMS, hospital administrators, and legislators.

Building

Triage & Pathway Support

Real-time decision support for rural EDs using SCAI staging, hemo-metabolic triggers, and transfer algorithms.

Building

Registry & QA

REDCap-based multicenter registry with AI-powered quality assurance, outcome tracking, and equity analytics across all network sites.

Future

Predictive Analytics

Machine learning models to predict deterioration, benchmark performance, and optimize resource allocation across the network.

We are actively seeking partnerships with leading AI companies to build the infrastructure for AI-enabled healthcare delivery across rural America.

Explore Partnership

Leadership

A multidisciplinary team across institutions.

Each of us keeps a north star — the vision board we actually navigate by. They are on this page on purpose. This network was built by people who lead from what they believe, and we would rather show you that than tidy it away.

Raymond Yau, MD, FSCAI — Chair, New Mexico Cardiogenic Shock Network
Chair

Raymond Yau, MD

Chief of Advanced Heart Failure & MCS
Heart Hospital of NM (Ardent Health)

Dr. Yau is an interventional and advanced heart failure cardiologist who founded NMCSN on a conviction: where you live should not decide whether you survive cardiogenic shock. He built the statewide protocols and leads the research behind them — including the five-year cohort in which 30-day survival rose from 37.6% to 59.4%.

My North Star →
Robyn Mitchell, ACNP — North Star vision board

My North Star

Executive Director

Robyn Mitchell, ACNP

Nurse Practitioner & Critical Care Expert
MCS Coordinator & POCUS Educator

Robyn is an acute care nurse practitioner and critical care expert. As MCS coordinator and POCUS educator, she trains the bedside clinicians whose ultrasound skills and early recognition the entire activation algorithm depends on.

Open full size →
Dominic DiDomenico, DO — North Star vision board

My North Star

Ambassador — St. Vincent / EM

Dominic DiDomenico, DO

Emergency Medicine Physician
ACEP NM President & EMS Medical Director

Dr. DiDomenico is an emergency medicine physician, President of the New Mexico chapter of ACEP, and an EMS medical director. He represents the network’s front door — the emergency rooms and EMS crews who make the first call.

Open full size →

Executive Board

Executive Director

Alex Truesdell, MD

Ambassador — UNM

Chip Sosa, MD

Ambassador — Presbyterian

Adam Banks, MD

Ambassador — St. Vincent / EM

Dominic DiDomenico, DO

Administrative Board

Research Director

Keisha Eggins

Treasurer

Dr. Ray Mitchell, DBA

Clinical Workgroup Leaders

ICU Workgroup

David Hoang, MD

CT Surgery Workgroup

David Joyce, MD

Get In Touch

Start a conversation.

Whether you run a hospital that wants to join the network, a foundation funding rural health, or you're a clinician with a question about the protocols — we answer every message.

Hospitals & Health Systems

Join as a hub or spoke site, or adopt the protocols at your center.

Email the network →

Funders & Foundations

Support rural health equity infrastructure with measurable outcomes.

Request our materials →

Clinicians & Researchers

Questions on the algorithms, or a paper we should be covering.

Ask a question →

Monthly Shock Literature

Every month we publish newly verified cardiogenic shock literature — open to everyone, no account and no subscription needed.

Read this month’s update →

Partner With Us

Build the future of rural healthcare with NMCSN.

New Mexico is a blank canvas — a small, diverse, geographically dispersed state where innovation can be tested, measured, and scaled. We are seeking partners who share our vision of AI-enabled, patient-centric systems of care. If you care for patients anywhere in New Mexico or the surrounding region, you are already in this network — there is no application, no minimum volume, and no agreement required to make a call.

Transfer a Patient

Call the shock line now — 1-888-727-7646. You do not need a confirmed diagnosis and you do not need an agreement in place. One call reaches the shock team. Not sure it qualifies? Run the activation tool.

AI & Technology Companies

Pilot AI tools for clinical decision support, registry analytics, documentation, and education in a real-world statewide network.

Health Systems & Hospitals

Every hospital has a role, whatever its cath lab status — see the capability tiers. For most Level 3 centers, joining means adopting the staging tool and the activation number. Formal agreements are being drafted; for now the first step is simply telling us you’re in — email admin@nmcsn.org.

Train Your Staff

POCUS education, shock recognition, and teaching material for ER, ICU, and EMS teams. Start with Focus on POCUS, or email admin@nmcsn.org to ask what is available.

Join the Registry

We are building New Mexico’s first prospective multicenter cardiogenic shock registry, with UNM as a founding academic partner. Tell us your institution is interested — admin@nmcsn.org.

Foundations & Government

Fund rural health equity infrastructure with measurable outcomes. NMCSN aligns with state and federal rural health transformation priorities.

Donors & Supporters

NMCSN is a nonprofit organization. Donations fund the work directly — statewide shock protocols, clinician education, and the registry that measures whether more New Mexicans survive. To donate or support the network, email admin@nmcsn.org.

Get in Touch

admin@nmcsn.org
Albuquerque, New Mexico

Raymond Yau, MD
Chair, NMCSN
Chief of Advanced Heart Failure & MCS
Heart Hospital of NM

References (7) — tap to expand
  1. Hochman JS, et al. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. N Engl J Med. 1999;341(9):625–634. PubMed
  2. Thiele H, et al. Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med. 2012;367(14):1287–1296. PubMed
  3. Sethi A, Hiltner E, et al. Association between hospital tiers and cardiogenic shock mortality: mitigating the transfer penalty through a regionalized hub-and-spoke model. medRxiv preprint, April 2026 — not yet peer reviewed. medRxiv
  4. Yau RM, Mitchell R, et al. Regionalized cardiogenic shock care in rural New Mexico: a single-center experience. Manuscript under review, 2026. Figures reflect our 313-patient cohort (2019–2024).
  5. Tehrani BN, Truesdell AG, et al. Standardized team-based care for cardiogenic shock. J Am Coll Cardiol. 2019;73(13):1659–1669. PubMed
  6. Papolos AI, et al. Management and outcomes of cardiogenic shock in cardiac ICUs with versus without shock teams. J Am Coll Cardiol. 2021;78(13):1309–1317. PubMed
  7. Basir MB, et al. Early utilization of mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock: the National Cardiogenic Shock Initiative. J Am Heart Assoc. 2023;12(23):e031401. PubMed

Figures cited from single-arm and before–after studies describe association, not causation. Reference 3 is a preprint and has not completed peer review; reference 4 is under journal review. Our own outcomes are reported in the Results section above.

Suspected cardiogenic shock?Level 1 Hub Transfer · 1-888-727-7646Call early — you do not need a confirmed diagnosis to activate.