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.

Indications for Non-COVID-19 Patients

Cardiac Indications for V-A ECMO

  • Cardiac index < 2.0 L/min/m2
  • Cardiac power output < 0.6 watts
  • Pulmonary artery pulsatility index < 1.5
  • Vasoactive-inotropic score (VIS) > 20
  • High dose single inotrope
  • Dual inotropic support
  • High dose or dual vasopressors
  • Worsening lactic acidosis
  • Early endorgan dysfunction

Respiratory Indications for ECMO

  • Acute respiratory failure/ARDS
  • Pulmonary contusion
  • Murray score > 3
  • PF ratio of < 100 for > 3 hours
  • pH < 7.25, PCO2 > 80, PaO2 < 60
  • High vent support
  • Plateau pressure > 25, PEEP > 10
  • Peak pressure > 40 

Contraindications to ECMO Support

  • Contraindication to systemic anticoagulation
  • Unrecoverable heart disease and not candidate for transplant, VAD or TAH
  • Age > 75 years
  • BMI > 50 kg/m2
  • Chronic 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 valve 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

Indications for COVID-19 Patients

At this time, we are limiting our evaluation of COVID-19-positive patients or patients under investigation (PUI) to the age of 65 years. Additional considerations for COVID-19-positive patients or patients under investigation include: 

  • No major underlying comorbidities
  • Primary respiratory failure (< 7d intubation)
  • P/F < 100 on PEEP > 5, prone positioning
  • No high mechanical ventilation for > 72 hours (FiO2 > 0.90, Pplat >30, driving pressure >15)
  • No need for renal replacement therapy
  • Normal neurologic function
  • Severe ARDS – undergoing prone positioning
  • Able to safely transport (hemodynamic stability, ventilatory parameters)
  • Not currently on nitric oxide (none of the vendors can transport NO)
  • No previous CPR

For more information, call 414-805-3666 or 800-272-3666.

For a physician-to-physician phone consultation or to initiate the shock protocol, call 414-805-4700 or 877-804-4700.

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