Italian Cardiogenic Shock Working Group

Group of physicians and other medical professional to clarify the management of

Cardiogenic Shock in Italy

Condivision of Experience & Opinion

No disclosure

Open & Spontaneous

1° Meeting Call: Milan, 2010 September

Ospedale SS. Orsola, BolognaOspedale San Gerardo MonzaAzienda Ospedaliera di Padova PadovaOspedale S. Camillo RomaOspedali Civili Riuniti BresciaIstituto San Raffaele MilanoOspedale Careggi FirenzeOspedale Le Molinette TorinoOspedale Niguarda MilanoAzienda Ospedaliera di Chieti ChietiOspedale Santa Maria degli Angeli UdinePoliclinico Gemelli RomaISMET Palermo

Ospedale SS. Orsola, BolognaOspedale San Gerardo MonzaAzienda Ospedaliera di Padova PadovaOspedale S. Camillo RomaOspedali Civili Riuniti BresciaIstituto San Raffaele MilanoOspedale Careggi FirenzeOspedale Le Molinette TorinoOspedale Niguarda MilanoAzienda Ospedaliera di Chieti ChietiOspedale S Maria degli Angeli UdinePoliclinico Gemelli RomaISMET PalermoAzienda Ospedaliera di Pisa PisaOspedale L. Sacco MilanoOspedale Monzino MonzaIstituto di Cura San Donato MilanoPoliclinico San Matteo PaviaOrganizzazione Emergenza 118 MilanoOspedale San Carlo MilanoAzienda Ospedaliera di Ravenna RavennaAzienda Ospedaliera di Verrona VeronaFICSICCHITACTA

While the ‘definitive’ treatment of cardiogenic shock depends of the cause,

the initial management and assessment are essential to limit the damage due to global tissue hypoperfusion

The key to good outcome in patients with cardiogenic shock

is an organized and multidisciplinary approach

Timing

Epidemiology of Cardiogenic Shock in Italy

LomardIMA RegistryItalian ISS (SDO)GISEAMCO

Licterature

Cardiac Therapy Hub & Spoke Organizations

Hub & Spoke Organization in Italy:

1. Level

2. Level: Cardiac Surgery Center

3. Level: Trasplant or VAD program Center

Aggressive approach to support the circulatory system in cardiogenic shock

with a extracorporeal life support is appropriate after

the failure of medical treatment and an IABP, when the cause is potentially reversible or

if the device can be used as a bridge option

IndicationControindicationTimingManagement of ECLS/ECMO: Cannulation

Anticoagulation ProtocolComplications TreatmentComplications Prevention

EducationDefine the technical, surgical and medical expertise

TREND ECMO 1986 - 2011

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PADOVA FIRENZE PAVIA MONZA PALERMO S.CAMILLO

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VA

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MediaGiornateDegenzaECMO

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AMB

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ECMO 2009

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ECMO 2011

Set Up ECMO circuit

FIRENZE PAVIA MONZA PALERMO PADOVA S.CAMILLO

WET NO NO NO DRY(WET)

NO

FIRENZE PAVIA MONZA PALERMO PADOVA S.CAMILLO

6 hrs(TFCPC 7-20)

12 hrs 8hrs 6 hrs V-A(TFCPC h24)

24 hrs V-V

24 hrs 12 hrs

Perfusionist Emergent/urgent

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PADOVA FIRENZE PAVIA MONZA PALERMOS.CAMILLO

EMERGENTE

URGENTE

URGENT

1,85/ ECMO

Emergent

1/18 ECMO

Transfer Programm

ECMO in Cath Lab

Acute Coronary Syndrome/PTCA

Ablation Procedure

TAVI procedure

ECMO program

Free diffusion?

Italian Cardiogenic Shock Working Group:

Position Paper for Cardiogenic Shock treatment

Use of ECMO in adult patients

Educational Program

http://www.sicch.org/index.html