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)