An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
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
Is your institution a milrinone shop or a dobutamine shop? Or do you have a mixed shop?It seems that most institutions are accustomed to use mostly one or the other in cardiogenic shock.Some argue that milrinone is better.Some argue that dobutamine is better.But do we know the answer?This was answered late in 2021 in the …
Continue reading Milrinone or Dobutamine in Cardiogenic Shock?
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