Plenary Session 13

3月28日［日］08:00-09:30

 
  Update of intensive care for cardiogenic shock
  
 
   
  集中治療室に入室する患者のなかでもとりわけ心原性ショックは、その方向性を見誤ると救命困難に至ることもあり、血行動態の評価および治療法の選択など迅速な決断を要する場合も散見される。心原性ショックの死亡率は1970年代に70％を超えていたが、2010年以降は30〜40％まで改善してきた。最近10年間で新しい補助循環装置も登場したが、現在の日本における心原性ショックの発生頻度と死亡率は不明である。わが国における心原性ショックの転帰を改善させるために病院前救護体制、病院収容後の救急診療、集中治療管理などの現状を把握することは重要である。本セッションの目的は、?地域での心原性ショックの発生頻度と予後予測因子、?循環器専門施設への集約化と早期治療開始の啓発、?心原性ショックの初期対応医と循環器専門医の連携および循環器専門医と集中治療専門医の連携、?急性心筋梗塞、急性心筋炎等の心原性ショックをきたす疾患ごとの病態の相違と転帰、?IABP、ECMO、IMPELLAなどの補助循環装置の効果と選択のタイミングおよび合併症予防（適応、導入、管理、離脱もしくはその限界）、など心原性ショックの死亡率改善の対策を講じることにある。本セッションではこの分野では先進的な施設での治療成績から最新の取り組みまでをも紹介していただき、このセッションを聴講したすべての参加者が明日からの心原性ショックの循環管理の実践に少しでもお役に立てれば幸いである。
Among patients admitted to intensive care units, especially, cardiogenic shock can cause difficulty in life-saving if its direction is mistaken. Situations that require quick decisions have been sporadically seen such as the evaluation of hemodynamics and the selection of treatment. The mortality rate of cardiogenic shock exceeded 70% in the 1970’s, but has improved to 30% to 40% since 2010. New cardiac assist devices have been developed during the last 10 years. However, the current incidence of, and mortality from, cardiogenic shock in Japan remain unclear. To improve the outcomes of cardiogenic shock in Japan, it is essential to understand the current situations such as the prehospital care system, intensive care after admission, and intensive care management. The aims of this session are to improve the mortality of cardiogenic shock on the basis of the following items: (1) prognostic factors for the incidence of cardiogenic shock in the community, (2) encouragement of treatment in cardiovascular hospitals and the start of early treatment, (3) cooperation between primary care physicians and cardiologists and between cardiologists and intensivists with cardiogenic shock, (4) understanding differences in pathological characteristics and outcomes according to diseases that may cause cardiogenic shock, such as acute myocardial infarction and acute myocarditis, and (5) the effectiveness and timing of the selection of percutaneous mechanical circulatory support devices such as intra-aortic balloon pumping (IABP), extracorporeal membrane oxygenation (ECMO), and Impella? systems and the prevention of complications (indications, induction, management, and withdrawal or limitations). In this session, we would like to introduce treatment outcomes and the latest approach in advanced hospitals in this field. We would be glad if this session could give all participants help in practicing the cardiovascular management of cardiogenic shock from tomorrow.
 
 
   
 
 
Yoshio Tahara   Yoshio Tahara
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita
   Robert W. Neumar   Robert W. Neumar
Department of Emergency Medicine, University of Michigan, Ann Arbor, USA
 
 
 
 
   
 
 
Robert W. Neumar   Robert W. Neumar
Department of Emergency Medicine, University of Michigan, Ann Arbor, USA
   Jun Takahashi   Jun Takahashi
Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai
 
 
 
Takeshi Yamamoto   Takeshi Yamamoto
Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Tokyo/The Cardiac Care Unit Committee, the Japanese Society of Intensive Care Medicine
   Hidekazu Aoyama   Hidekazu Aoyama
Department of Cardiology, Nagoya Tokushukai General Hospital, Kasugai
 
 
 
Hidetoshi Hattori   Hidetoshi Hattori
Department of Cardiology, Tokyo Women's Medical University, Tokyo
   Kenichiro Sawada   Kenichiro Sawada
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita