Grupo Español de Shock
Prof. Dr. Ana Navío MD PhD
Spanish National Director of Shock
Grupo Español de Shock
ALCALA, SCHOOL OF MEDICINE
LA PAZ, HOSPITAL, MADRID
Grupo Español de Shock
FERNANDO ABAD ESTEBAN
SIRA AGUILÓ MIR
SUMMA 112
Hospital Clinic, Barcelona
2
ELENA ALVARO JAÚREGUI
H. La Fe , Valencia
3
JOSE EMILIO ALONSO LASHERAS
HU, Tenerife
4
DANIEL AFONSO RIVERO
H. La Princesa, Madrid
5
Mª ANGELES ARAGÓN LEAL
H. de Jerez, Cádiz
6
MAITE AYUSO ARAGONÉS
H. La Paz , Madrid
7
VANESA BLASCO FRAILE
H. La Paz , Madrid
8
CONSUELO CANENCIA HERNÁNDEZ
SAMUR Ayto Madrid
9
JUAN CAÑERO CRIADO
H.Virgen de Victoria , Málaga
10
JUAN CARLOS COBO BARQUIN
Hospital Central, Asturias
11
MANUEL CUESTA MARTÍN
H. Cruces, Bilbao
12
SONIA FERNANDEZ-ARRUTY FERRO
Hospital U. de Santiago, Coruña
13
VANESA GALLEGO VILLALVILLA
H.12 de Octubre, Madrid
1
Grupo Español de Shock
JOSE CARLOS GARCÍA CARAVACA
H. Morales Meseguer, Murcia
CARMEN GARGALLO MAICAS
H. La Fe, Valencia
ISABEL GIL ROSA
H. Reina Sofía, Murcia
ELENA GOMEZ DEL PULGAR CARRILLO
H. La Paz, Madrid
ELBA GONZALEZ DE LINARES
H. Marqués de Valdecilla, Santander
PABLO GUALLAR SOLA
Fundación Hospital de Calahorra, Zaragoza, La Rioja
ROCIO JIMENEZ GÓMEZ
Hospital U.de Puerto Real, Cádiz
AMAIA IBARRA BOLT
Hospital Virgen del Camino, Navarra
VICTOR MARQUINA ARRIBAS
H.G. Alicante
ESTHER MARTÍNEZ LARRUL
H. Gregorio Marañón, Madrid
GUILLERMO MURILLO PUTZE
Complejo Hospitalario U.de Canarias
ANA NAVÍO SERRANO
H. , Madrid
OSCAR ORTIGOSA AGUSTÍN
H Miguel Servet, Zaragoza
GERARDO PALACIOS MARÍN
Fundación Hospital de Calahorra ,La Rioja
Grupo Español de Shock
FELIPE PASCUAL CLEMENTE
H. Ramón y Cajal, Madrid
ERNESTO PERALES PIQUERES
H G Cáceres
RAMÓN PERALES PARDO
UCH Albacete
AITANA PEREZ FENANDEZ
Fundación Hospital de Calahorra ,La Rioja
VERONICA REINA LORA
H.Puerta del Mar, Cádiz
FRANCISCO DE BORJA QUERO ESPINOSA
H Reina Sofía, Córdoba
MICHEL RIESCO GARCÍA
H.U. de Salamanca
ALEJANDRO RODRIGUEZ CAMACHO
Hospital Puerta del Mar, Cádiz
ANTONIO ROJAS RAMIREZ
H. Osuna ,Sevilla.
FRANCISCO JAVIER RUBIO ALONSO
H Son Llazter, Mallorca
FRANCISCO JAVIER RUIZ CASTILLA
Hospital de Jerez, Cádiz
ANA SAGARRA LOZANO
H.Puerta del Mar, Cádiz
CRISTINA MARTIN DOMINGUEZ
H. S. Pedro de Alcantara, Cáceres
Grupo Español de Shock
FUENSANTA SORIANO RODRIGUEZ
Hospital Infanta Margarita de Cabra
JUAN SINISTERRA AQUILINO
S.E.S. Alicante
JOSE MANUEL TORRES MURILLO
H Reina Sofía, Córdoba
JOSE MANUEL VALLES TARAZONA
H. La Fe, Valencia
(Córdoba).
Grupo Español de Shock
OBJECTIVES
THE AIM OF THIS STUDY IS TO TRY
TO FIND THE SCORE FOR ASESSING
THE OUTCOME OF PATIENTS WITH
SHOCK
AT
THE
EMERGENCY
DEPARTMENTS, IN REAL TIME.
Grupo Español de Shock
HISTORY I
PREVIOUS INVESTIGATIONS HAVE
SHOWN THAT MOST OF THE SCORES
POSSES, INADEQUATE PREDICTIVE
ABILITIES TO ED POPULATION .
Jones AE, Fitch MT, Kline JA.Operational performance of validated phisiologic
scoring systems for predicting in hospital mortality among critically ill
emergency patients. Crit Care Med 2005; 33:974-978.
Jones AE, Saak K, Kline JA. Perfomance of the mortality in emergency department
sepsis score for predicitng hospital mortality among patients with severe
sepsis and septic shock. Am J Emerg Med 2008, 25(6):689-692
Grupo Español de Shock
HISTORY II
SCORING
SYSTEMS
HAVE
BEEN
EXPLORED IN THE ICU,
HOWEVER,
RISK
STRATIFICATION
TOOLS ARE LESS COMMONLY USED
IN ED.

Hargrove J, Nguyen HB,. Bench to beside review: outcome
critically ill patients in the ED. Crit Care 2005; 9. 376-83
predictions
for
Grupo Español de Shock
STUDY DESIGN I
→PROSPECTIVE,
→OBSERVACIONAL ,
→MULTICENTER ,
→INTERNATIONAL ,
→APPROVED BY THE LOCAL ETHICS
COMMITEES
Grupo Español de Shock
COUNTRIES
→ARGENTINA,
→PARAGUAY,
→COLOMBIA,
→VENEZUELA,
→MEXICO,
→SPAIN
Grupo Español de Shock
STUDY DESIGN II
INTERNATIONAL COORDINATORS:
Dr. Gustavo Piñero ,MD, PhD.
Emergency phisician at the Bahía Blanca “Dr.
Leónidas Lucero” Hospital.
Associate Professor at the National University of the
South, Bahía Blanca
Argentina
gusrepi@speedy.com.ar
Grupo Español de Shock
STUDY DESIGN II
INTERNATIONAL COORDINATORS:
Dra. Ana Navío ,MD, PhD.
Emergency phisician at La Paz Hospital, Madrid ,
Spain.
Associate Professor at the Alcalá School of Medicine,
Madrid
Spain
navio.ana@gmail.com
Grupo Español de Shock
STUDY SETTING
PATIENTS WERE ENROLLED AT
SEVERAL :
URBAN,
TERTIARY,
WITH A CENSUS OF MORE
THAN 100.000 ANUAL ED VISITS
Grupo Español de Shock
BACKGROUND
E.D. phisicians must be experts in the rapid
recognition of the diagnosis and outcome of
shock and the targeted intervention, to
reduce morbidity , mortality and costefectivenes.
Grupo Español de Shock
METHODS
Data has been collected during 3
months by the investigators and held
and analyzed by an statistical team in
Madrid.
 Number of patients estimated : 3000
Grupo Español de Shock
ENROLLMENT WAS LIMITED TO PATIENTS WITH
PATIENTS WITH AGE BETWEEN 14100 YEARS OLD
SBP< 110 mmHg or hypertense with
a falling down of more than 30%.
Grupo Español de Shock
ENROLLMENT WAS LIMITED TO PATIENTS WITH
 EVIDENCE OF :
LACTIC ACIDOSIS,
SIGNS OF LOW PERFUSSION :
OLIGURIA< 30 CC/H,
CONSCIOUSNESS
Grupo Español de Shock
E XC LU S I O N C R I T E R I A I N C LU D I N G
PREGNANT WOMAN,
NO
PREFORM
OF
CRITERIA
INCLUSION
Grupo Español de Shock
METHODS OF MEASUREMENT
A standardized abstraction form was
created for data collection.
For both emergency teams, pre and
in hospital departments .
Grupo Español de Shock
SCORE DEFINITIONS I
MEASUREMENTS
TIME
DELAY IN FILLED
CAPILLARY
sg
BSP mmHg
VENOUS OXYGEN
SATURATION
0
1
2
3
0h
<2
3-4,5
4,6-5
>5
>110
71 85
101-109
61 - 70
91-100
51 - 60
>90
< 50 o
> 85
NEGATIVE BASE
EXCESS
LACIDEMIA (mMol /l)
<3
4-9
10 - 14
< - 15
<1
1,1 – 2
2,1 – 4
>4
ARTERIAL
PRESSURE FiO2
RCP(mg/l)
> 300
201 - 299
< 200
<5
6 - 50
199 200
51 - 100
PROCALCITONIN
<0,1
0,1-0,25
0,260,50
>0,5
PRO- ADM
FROM 0 TO 24
POINTS
> 100
6h
24 h
Grupo Español de Shock
SCORE DEFINITIONS II
MEASUREMENTS
0
1
2
3
TIME
0h
DELAY IN FILLED
CAPILLARY
sg
SBP mmHg
<2
3-4,5
4,6-5
>5
>110
101-109
91-100
>90
DBP mmHg
>80
70-79
69-60
<59
HEART BEAT ppm
>100
90-99
80-89
<80
RESPIRATORY RATE rpm
>40
30-39
20-29
<20
PERIPHERAL OXYGEN
SATURATION %
71 – 90
61 - 70
51 - 60
< 50 o >
85
PRE-HOSPITAL
Grupo Español de Shock
Number of data fields per patient
were:25
 And as medical information :
Grupo Español de Shock
 AGE
 SEX: MALE/FEMALE
→ CHRONICLE RENAL INSUFICIENCY
→ CHRONICLE HEART FAILURE
→ CHRONICLE BRONCHITIS
→ CHRONICLE LIVER DISEASE
Grupo Español de Shock
FIRST SHOCK INDEX (FC / TAS)
 SOFA SCORE
 KIND OF SHOCK
FIRST SUEROTHERAPY
Grupo Español de Shock
Grupo Español de Shock
TRANSFUSSION: WHAT/ DOSAGE
RED CELLS, PLAQUELETS, PLASMA
 VASO PRESSOR DRUGS: WHICH /DOSAGE
CORTICOTHERAPY : WHICH/DOSAGE
Grupo Español de Shock
We know, how early we must identify the
patient in shock, but we do not know , as
well, the severity during the evolution and
the measurable improvements in mortality
and
morbidity
rates,
as an answer of our therapy.
The results of the ISSS study, perhaps, will
help us to find the answers.
Grupo Español de Shock
Grupo Español de Shock
Grupo Español de Shock
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