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,
Ospedale San Gerardo
Azienda Ospedaliera di Padova
Ospedale S. Camillo
Ospedali Civili Riuniti
Istituto San Raffaele
Ospedale Careggi
Ospedale Le Molinette
Ospedale Niguarda
Azienda Ospedaliera di Chieti
Ospedale Santa Maria degli Angeli
Policlinico Gemelli
ISMET
Bologna
Monza
Padova
Roma
Brescia
Milano
Firenze
Torino
Milano
Chieti
Udine
Roma
Palermo
Ospedale SS. Orsola,
Ospedale San Gerardo
Azienda Ospedaliera di Padova
Ospedale S. Camillo
Ospedali Civili Riuniti
Istituto San Raffaele
Ospedale Careggi
Ospedale Le Molinette
Ospedale Niguarda
Azienda Ospedaliera di Chieti
Ospedale S Maria degli Angeli
Policlinico Gemelli
ISMET
Azienda Ospedaliera di Pisa
Ospedale L. Sacco
Ospedale Monzino
Istituto di Cura San Donato
Policlinico San Matteo
Organizzazione Emergenza 118
Ospedale San Carlo
Azienda Ospedaliera di Ravenna
Azienda Ospedaliera di Verrona
FIC
SICCH
ITACTA
Bologna
Monza
Padova
Roma
Brescia
Milano
Firenze
Torino
Milano
Chieti
Udine
Roma
Palermo
Pisa
Milano
Monza
Milano
Pavia
Milano
Milano
Ravenna
Verona
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 1986 - 2011
80
70
60
CARD PED
RESP PED
CARD AD
RESP AD
TOTALE
50
40
30
20
10
10
20
08
20
06
20
04
20
02
20
00
20
98
19
96
19
94
19
92
19
90
19
88
19
19
86
0
TREND ECMO 2007 - 2011
80
70
60
PAVIA
MONZA
S.CAMILLO
FIRENZE
PADOVA
PALERMO
50
40
30
20
10
0
2007
2008
2009
2010
2011
100
90
80
70
60
50
40
30
20
10
0
PEDIATRICO
ADULTO
PADOVA
FIRENZE
PAVIA
MONZA PALERMOS.CAMILLO
VV - VA
100
90
80
70
60
50
40
30
20
10
0
VV
VA
PADOVA
FIRENZE
PAVIA
MONZA
PALERMO S.CAMILLO
12
10,9
10
8,1
8
7
6
5,9
2007
2008
6
4
2
0
2009
2010
2011
Media
Giornate
Degenza
ECMO
N° Transfert
35
30
25
20
ELIC
AMB
15
10
5
0
PADOVA
FIRENZE
PAVIA
MONZA
PALERMO S.CAMILLO
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
ECMO 2008
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
ECMO 2009
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
ECMO 2011
Set Up ECMO circuit
FIRENZE
PAVIA
MONZA
PALERMO
PADOVA
S.CAMILLO
WET
NO
NO
NO
DRY
NO
(WET)
FIRENZE
PAVIA
MONZA
PALERMO
PADOVA
S.CAMILLO
6 hrs
12 hrs
8hrs
6 hrs V-A
24 hrs
12 hrs
(TFCPC 7-20)
(TFCPC h24)
24 hrs V-V
Perfusionist Emergent/urgent
600
500
400
EMERGENTE
URGENTE
300
200
100
0
PADOVA
FIRENZE
PAVIA
MONZA PALERMOS.CAMILLO
Emergent
URGENT
1,85/
ECMO
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