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Austria Working Group Cardiovascular Intensive Care Medicine

Testimonials from Prof. Alexander Geppert, MD (Chairperson)

Acute Cardiac Care


The Working Group on Cardiovascular Intensive Care Medicine (Cardiovascular ICM) of the Austrian Society of Cardiology is a relatively young Working Group (constitution 13y ago), originating from the idea to propagate cardiovascular ICM in Austria and the understanding that critically ill patients with cardiovascular diseases often necessitate different treatments than general  ICU patients, and  different approaches to their critically illness (with special attention to the heart).
Currently 8-10 members of the Working Group constitute the Nucleus of the Working Group, all of them being not only specialists in Internal Medicine and Cardiovascular Medicine but also specialists of Intensive Care Medicine and  some of them also specialist in Cardiac (especially Coronary) Interventions.

What are the main issue encountered in your country in the way of acute cardiovascular disease are managed?

Cardiovascular Intensive Care Medicin is a further specialisation of  acute cardiovascular medicine and focuses on the hemodynamically unstable, respiratory unstable cardiac patient with failure or dysfunction of one or more organ systems that needs treatment on an ICU (more than a CCU). Noteworthy we take also care of patients that have acute cardiovascular diseases but do not already necessitate an ICU bed. However, there is – not only in Austria but world wide- a lack of specialisation/expertise once the acutely ill cardiovascular patient becomes to a critically ill patient necessitating organ support. One of the best examples is the approach to the treatment of patients with cardiogenic shock that is more than coronary revascularisation and inotropic therapy.

We closely collaborate with Anesthesiologists (especially those taking care of patients after cardiothoracic surgery) with Specialist in Intensive Care Medicine (especially from the Austrian Society of Intensive Care Medicine), specialist in Emergency Medicine and Specialists in Cardiothoracic Surgery (since VAD´s are nowadays a lifesaving therapeutic option for our critically ill patients). The Heart team approach to the patient is in our opinion also the way how one should approach to the field of Cardiovascular ICM.

What are your main project/achievements?

One of our main achievements was certainly the work on the Guidelines to treat infarct-related cardiogenic shock in collaboration with the Austrian Society of Intensive Care Medicine, the German Societies of Cardiology and Intensive Care Medicine. This work took 5years to be accomplished (more than 30 specialists involved) and the guidelines have been published online and  in print (more than 150 pages, see: S3 Leitlinien zur Behandlung des Infarktbedingten kardiogenen Schocks).These guidelines treat this complex theme in both a “cardiologist way” as well as an “intensivist way”. Coronary Revascularization, Organ Perfusion and Organ Oxygenation, Respiratory and Hemodynamic Stabilization and Prevention of Organ Failure have been identified as the main and equivalently important goals in the treatment of patients with infarct related cardiogenic shock. The work with these other societies generated a fruitfull atmosphere with many scientific projects and close collaborations  beyond the work on the guidelines.
Our next important  project starting in 2011 that should soon be achieved (planned for autumn 2013) is the work on guidelines for the use of ECMO in adult patients with cardiovascular diseases. Specialist of cardiac surgery, cardiology, intensive care medicine, anaesthesiology meet regularly to formulate these guidelines for ECMO use that should be more detailed more precise than the available ELSO guidelines especially with concern to treatment of patients on ECMO, treatment of complications and weaning from ECMO.
Other important projects: We are planning a Refresher-Rookie course on Cardiovascular ICM to start with 2014 and have a well established post graduate course on Cardiovascular ICM (celebrating it´s 10th anniversary this year: Baden near Vienna usually in may) in order to promote Cardiovascular ICM in Austria.

What do you expect from your collaboration with ACCA/ESC?

A collaboration with ACCA can be fruitful in several ways:

- Close collaboration with specialists troughout Europe is important to quicker recognize specific problems in the field and  also specific opportunities and to quicker react on new emerging trends.
- Concentration of efforts in a more and more busier world, with faster communication possibilities and exchange of knowledge e.g. adoption of  guidelines
- Promotion of Cardiovascular ICM throughout Europe (since the critically ill patient with cardiovascular disease has specific needs!)
- Greater  chance of success for scientific and educational projects  that can perhaps be undertaken easier, quicker and on a large base with more power to acquire financial support from the industries, allowing multinational multicenter controlled randomized studies on important fields in Cardiovascular ICM.