I would like to make a few points of clarification for yesterday tweet on Vasopressin for cardiogenic shock.
🔑 point: Vasopressin is not “preferred” nor 1st line in CS but “may be considered” in select cases
Please read further thread 👇🏻👇🏻
🔑 point: Vasopressin is not “preferred” nor 1st line in CS but “may be considered” in select cases
Please read further thread 👇🏻👇🏻
It should have stated “may consider” VP as the suggestion of benefit in the JAHA article on CS was based on theoretical benefit and a ☝️ post hoc analysis of the VASST trial which included septic shock patients, notably a VERY different pathophys than CS.
pubmed.ncbi.nlm.nih.gov/22518026/
pubmed.ncbi.nlm.nih.gov/22518026/
Article did not also mention potential risk of harm from Vasopressin. (fluid retention, lack of inotropic activity, etc) and as @brentnreed pointed out, patients in this study required MORE inotropic support when vasopressin was used 
An individualized approach is 🔑 assessing the etiology of CS, concurrent PAH,HFpEF & hemodynamics (⬆️⬇️SVR, ⬆️⬇️CI) to select a vasopressor vs. inotropic support.
The wording as a statement of fact which should have come across as a suggestion. See great thread from @JJRyanMD on management of CS in PAH 👇🏻
https://twitter.com/jjryanmd/status/1300948291257921536?s=21
https://twitter.com/JJRyanMD/status/1300951470116798465
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