Do you know how to manage cardiogenic shock?

This week's ResusX:Podcast features Dr. Colin McCloskey, an EM Intensivist, provides valuable insights on identifying and managing Cardiogenic Shock. This life-threatening condition has a 50% in-hospital mortality rate. He highlights the importance of differentiating it from other shocks, emphasizing key signs such as low systolic blood pressure, narrow pulse pressure, and cool extremities. Echocardiography and bedside physical examination play a crucial role in confirming the diagnosis.
Dr. McCloskey discusses resuscitation, starting with inopressors to defend MAP, with norepinephrine as the first-line choice. Inotropic medications like dobutamine or milrinone may be used if needed to improve cardiac output and coronary perfusion pressure. Mechanical circulatory support devices can be considered when inotropes are insufficient, and a multidisciplinary approach involving heart failure cardiologists, cardiac surgeons, and CT intensivists is crucial for optimal management. Early diagnosis, appropriate medical care, and collaboration among healthcare professionals are highlighted as essential factors in effectively managing Cardiogenic Shock and improving patient outcomes.
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00:00 Introduction and Overview of Cardiogenic Shock
00:50 Identifying Cardiogenic Shock in the Sea of Sepsis
02:51 Understanding the Underlying Causes of Cardiogenic Shock
03:49 Resuscitation Strategies for Cardiogenic Shock
04:47 The Role of Inotropes in Cardiogenic Shock Management
06:21 Mechanical Circulatory Support Devices for Cardiogenic Shock
08:21 The Importance of Teamwork in Managing Cardiogenic Shock
09:02 Conclusion: Key Steps in Managing Cardiogenic Shock

[@AlexanderRoux]

CCN = Legends!

[@CriticalCareNow]

Thank you for that!

[@Bastakology]

awesome video, thank you!

[@CriticalCareNow]

Greatly appreciate it, thank you.

[@rumit9946]

wow just brilliant thanks so much

[@CriticalCareNow]

Thanks for watching

[@emelsibaja4369]

Great talk!
In a patient having either AMICGS or HF-shock a swan will help determining the phenotype and hemodynamic profile of the patient. Based on the hemodynamics you can make decisions as far as which drugs to use, is the current treatment working, do I need to escalate, do you need univentricular or bi-V support? Pressure doesn’t equal flow, sometimes the map may be adequate at 60 other times it needs to be higher. For example, in patient with CGS and a SVR of 4000 and very hypotensive, adding Levo is not the best choice. In this setting, a trial of nipride may actually help more than levo. Once SVR drops, forward CO will improve. Attaching one paper recently released by the group from Detroit, they have contributed so much the CGS field. Additionally, also attaching the SCAI shock statement paper which is enforced by the AHA/ACC/SCCM which focuses is describing shock based on categories.

[@CriticalCareNow]

This comment is gold! Thank you

[@farhanqadeer82]

Fantastic talk - Loved the idea of Levo to save the MAP. Starting ionotropes before Levo or some kind of pressor results in disaster. My question/ comment.
1. When do you consider SWAN in these patients.
2. How do you wean Ionotropes based on what criteria? MAP versus CO/CI versus non invasive monitoring versus SWAN numbers?
3. What parameter do you use to consider transferring patient to dedicated CVICU.
4. Do you consider renal function when chosing your Ionotropes. considering milrinone is renally excreted.
5. Does A fib wit RVR stops you from using Levo or Dobutamine
6. I personally like to use Lasix gtt over lasix pushes ( based on my fellowship expeirence with Pul HTN patients - more control over their volume status).
7. When do you add on Vasodilator.
Thanks a lot. Hoping to come for your Oct meeting.
Farhan

[@CriticalCareNow]

Will ask Colin about your questions. Hope to see you soon

[@rustynail2310]

If shock is VASOCONSTRICCIÓN, why then VASOPRESOR????