Post on 07-Jan-2016
description
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
0
10
20
30
40
50
60
70
80
CARD PEDRESP PEDCARD ADRESP ADTOTALE
TREND ECMO 2007 - 2011
0
10
20
30
40
50
60
70
80
2007 2008 2009 2010 2011
PAVIAMONZAS.CAMILLOFIRENZEPADOVAPALERMO
0
102030
4050
6070
8090
100
PADOVA FIRENZE PAVIA MONZA PALERMOS.CAMILLO
PEDIATRICO
ADULTO
VV - VA
0
10
20
3040
50
60
7080
90
100
PADOVA FIRENZE PAVIA MONZA PALERMO S.CAMILLO
VV
VA
6 5,9
8,1
10,9
7
0
2
4
6
8
10
12
2007 2008 2009 2010 2011
MediaGiornateDegenzaECMO
N° Transfert
0
5
10
15
20
25
30
35
PADOVA FIRENZE PAVIA MONZA PALERMO S.CAMILLO
ELIC
AMB
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
123456789
10111213141516171819202122232425262728293031323334353637383940414243444546474849505152535455565758
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
0
100
200
300
400
500
600
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