CREAZIONE DI UN PERCORSO CLINICO-ORGANIZZATIVO INTRAOSPEDALIERO PER LA REALIZZAZIONE DI UN SERVIZIO DI ASSISTENZACARDIOCIRCOLATORIA NEL TRATTAMENTO DELLO SHOCK CARDIOGENO

In-hospital protocol to produce a Cardiocirculatory Support Team for the cardiogenic shock therapy. Objectives: Cardiogenic shock carries a very high mortality. Veno-Arterial extracorporeal membrane oxygenation (ECMO) using the PLS MAQUET (Rastatt, Germany) has been adopted as a first line treatment of Cardiogenic shock as a “bridge to decision” strategy. In the study the data coming from our clinical experience has been used to elaborate protocols in order to formulate an Organizational Project Methods: From January 2011 until December 2013 twenty-three ventricular assist devices have been implanted at our institution on patients with Cardiogenic Shock. Among all the patients treated, 6 patients developed cardiac shock after cardiac surgery, 10 developed cardiac shock during interventional cardiology procedures, 5 were patients with cardiac shock coming from the community and 2 patients developed ARDS after cardiac surgery. The Cannulation approach for the ECMO included Femoral Vein, Femoral artery, Axillary artery or internal Jugular Vein. Regarding the Cannulation technique, 12 (52.17%) were performed using a percutaneous approach with Seldiger Technique while 11(47.82%) were performed directly with surgical approach. Additional Intra-Aortic Balloon Pump devices were used in 10 patients (43.48%). Results: The mean Age of the patients was 63.2 yrs (Range 29-88). Twenty-two were male patients and one was female. Mean duration of the treatment was 3.34 days (Range 1-27 days). Thirteen patients were successfully weaned from ECMO (56.2%). After a follow-up period of up to 3 years the mortality at 30 days, 8 month, 12 month and 24 month were respectively 100%(13), 84.62% (11), 23.07% (3) and 7.69% (1). Ten patients (43.48%) died during ECMO secondary to multi-organ failure. Conclusion: In our experience the use of the ECMO, as a “ Bridge to Decision”, in Patients with Cardiac Shock was followed by better outcome where the time frame from the indication/decision time to the actual starting treatment was less than 15 min and patient within the Hospital. A thorough periodical review of guide lines for the management of these patient is indeed of crucial importance. Also periodical training sessions with or without simulation courses are of essential relevance in order to improve the skills of the team involved in reviewing and managing all the ECMO devices.