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, Bologna Ospedale San GerardoMonza Azienda Ospedaliera di PadovaPadova Ospedale S. CamilloRoma Ospedali Civili RiunitiBrescia Istituto San RaffaeleMilano Ospedale CareggiFirenze Ospedale Le MolinetteTorino Ospedale NiguardaMilano Azienda Ospedaliera di ChietiChieti Ospedale Santa Maria degli Angeli Udine Policlinico GemelliRoma ISMETPalermo

Ospedale SS. Orsola, Bologna Ospedale San GerardoMonza Azienda Ospedaliera di PadovaPadova Ospedale S. CamilloRoma Ospedali Civili RiunitiBrescia Istituto San RaffaeleMilano Ospedale CareggiFirenze Ospedale Le MolinetteTorino Ospedale NiguardaMilano Azienda Ospedaliera di ChietiChieti Ospedale S Maria degli Angeli Udine Policlinico GemelliRoma ISMETPalermo Azienda Ospedaliera di PisaPisa Ospedale L. SaccoMilano Ospedale MonzinoMonza Istituto di Cura San DonatoMilano Policlinico San MatteoPavia Organizzazione Emergenza 118Milano Ospedale San CarloMilano Azienda Ospedaliera di RavennaRavenna Azienda Ospedaliera di VerronaVerona FIC SICCH ITACTA

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 Registry Italian ISS (SDO) GISE AMCO 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

Indication Controindication Timing Management of ECLS/ECMO: Cannulation Anticoagulation Protocol Complications Treatment Complications Prevention Education Define the technical, surgical and medical expertise

TREND ECMO

TREND ECMO

VV - VA

N° Transfert

ECMO 2008

ECMO 2009

ECMO 2011

Set Up ECMO circuit FIRENZEPAVIAMONZAPALERMOPADOVAS.CAMILLO WETNO DRY (WET) NO

FIRENZEPAVIAMONZAPALERMOPADOVAS.CAMILLO 6 hrs (TFCPC 7-20) 12 hrs8hrs6 hrs V-A (TFCPC h24) 24 hrs V-V 24 hrs12 hrs

Perfusionist Emergent/urgent

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