An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
A definite hat tip to my buddy Matt Siuba (zentensivist.com) and his colleagues for this great review on the management of right ventricular (RV) dysfunction in patients with ARDS. I plan on elaborating further on this paper but the bottom line is that we need more data. For now, head down to the citations to …
With a close to 50% mortality rate for cardiogenic shock, we all need a do a better job of caring for these patients. A cardiogenic shock classification would help identify who needs the most help.This is created for anyone caring for cardiogenic shock including physicians, APPs and nurses.We are all in this together. The earlier …
Continue reading Cardiogenic Shock: SCAI Stage Classification
Mortality for patients in cardiogenic shock is finally improving to be less than 50%. It had been hovering at 50% for decades. Would floating a Swan Ganz catheter, also known as a Pulmonary Artery Catheter improve outcomes in Cardiogenic Shock? The ESCAPE trial took the winds out of the sails of the Swan-Ganz enthusiasts in …
Continue reading Cardiogenic Shock & Swan-Ganz/Pulmonary Artery Catheters
To not fly blind in patients with advanced heart failure or cardiogenic shock, certain equations exist to help us manage our patients. This allows us to identify who is not doing well and act on their deterioration before it really hits the fan. We use cardiac power output (CPO), which I have dissected in THIS …
Continue reading Pulmonary Artery Pulsatility Index (PAPi): Principles & Calculation
There are few options when it comes to right ventricular support for patients who are in right heart failure from a multitude of etiologies. At the time of this writing, we are limited to two temporary percutaneous right ventricular assist devices (RVAD) to assist our patients with this problem: the Impella RP and the Protek …
Continue reading Protek Duo Right Ventricular Assist Device (RVAD) ProtekDuo
Mortality in Cardiogenic shock, historically speaking, is around 50%. Everyone knows that we need to get better. An amazing push in sepsis management has significantly decreased the mortality of that pathology. The last decade has seen many advances towards improving mortality but without robust results, unfortunately. Inotropes and vasopressor have failed at saving lives. There …
Continue reading Impella vs. VA-ECMO for Cardiogenic Shock s/p Myocardial Infarction
Let's start off with the basics. ECMO is the medical abbreviation for Extra Corporeal Membrane Oxygenation. This means that the system takes blood out of your body run its through a circuit, and puts oxygen into it. It can obviously do other things which I will cover below. There are two types of ECMO, VA …
Let me start off by saying that not every patient who is hypotensive is septic, contrary to what every medicine resident thinks. I could say that because I was a medicine resident at one point. There are 3 other types of shock that are not distributive. We are here to talk about the Cardiogenic kind …
Continue reading Cardiogenic Shock: Mechanical Circulatory Support; Rise of the Machines
ELSO, the Extracorporeal Life Support Organization, is now doing free training course/modules/program on ECMO (extracorporeal membranous oxygenation), both VV and VA in this COVID-19 time. Take advantage! You need to register, of course. It has been over two years since I did ECMO and this is a good refresher course for me. Check it out …
Continue reading ECMO in Adults Training Course for FREE from ELSO
This is my first of many posts on the Impella system by Abiomed. It is going to be part of my "Cardiogenic Shock: Rise of the Machines" lecture for Portland in August 2020. I am planning on covering LVADs, RVADs, ECMO, TandemHeart, etc. in the upcoming months but one does not need to work at …
Continue reading Impella Medical Device: Using the Detroit Cardiogenic Shock Protocol