The Froedtert & MCW Cardiogenic Shock Program provides a 24/7 resource for patients in cardiogenic shock. A multidisciplinary team takes a coordinated approach to evaluating patients and working rapidly with referring physicians to provide patients with the advanced care they need.
To initiate the shock protocol, call the Froedtert & MCW Access Center at 414-805-4700.
Cardiac Considerations for Veno-Arterial (V-A ECMO)
- Cardiac index ≤ 2.0 L/min/m2
- Cardiac power output (CPO) < 0.6 watts
- Pulmonary artery pulsatility index (PAPi) ≤ 1.5
- Vasoactive-inotropic score (VIS) > 20
- High dose or dual inotrope use
- High dose or dual vasopressor use
- Worsening lactic acidosis Lactate > 2 mmol/L, Ph < 7.35
- End-organ dysfunction
- SCAI score C or greater
- Mixed venous oxygen Saturation (SvO2) < 60%
- Central Venous Pressure (CVP) >15 mmHg
- Pulmonary Capillary wedge pressure (PCWP) ≥ 15 mmHG
- Central Venous Pressure (CVP) / Pulmonary Capillary Wedge Pressure (PCWP) Ratio > 0.63 mmHg
- Echocardiographic findings — left ventricular (LV) dysfunction | right ventricular (RV) dysfunction | large territory of regional wall motion abnormality
- Ability to safely transport (hemodynamic stability, ventilatory parameters)
Respiratory Considerations for Veno-Venous (V-V ECMO)
- Acute Respiratory Failure/ Acute Respiratory Distress Syndrome (ARDS)
- Pulmonary Contusion
- Murray Score > 3
- PF ratio of < 100 for > 3 hours
- pH < 7.25, PCO2 > 80, PaO2 < 60
- Plateau Pressure > 25, PEEP > 10
- Peak Pressure > 40
Relative Contraindications to ECMO Support
- Contraindication to systemic anticoagulation
- Unrecoverable heart disease and deemed not a candidate for transplant, Ventricular Assist Device (VAD) or Total Artificial Heart (TAH)
- Age > 75 years
- BMI ≥ 60 Kg/m2
- Chronic end organ dysfunction (emphysema, cirrhosis, renal failure)
- Mechanical ventilation at high settings (FIO2 > 0.9, P-plat > 30) for ≥ 7 day
- Chest compressions not initiated within 10 minutes of arrest (either bystanders or EMS)
- 15 minutes CPR without stable ROSC
- Acute or chronic aortic dissection
- Severe aortic valvular regurgitation
- Known intracranial hemorrhage
- Pre-existing severe neurological disease (including traumatic brain injury, stroke or severe dementia)
- Terminal stage malignancy
- Cardiac arrest of traumatic origin with uncontrolled bleeding
- Irreversible organ failure leading to cardiac arrest
- Inability to safely transport (hemodynamic stability, ventilatory parameters)