Randomised clinical trials in cardiogenic shock in the PCI era
Treatment considerations for patients with AMI-cardiogenic shock
Enrolment data for major randomised cardiogenic shock trials (EuroIntervention 2021; 17: 451-65)
Determination of the Society for Cardiovascular Angiography and Intervention (SCAI) Shock stage using the revised SCAI Shock Classification
Conceptual model showing the overlap between
different states of hemodynamic compromise. Shock is defined by presence of hypoperfusion; most, but NOT ALL, patients will also be hypotensive. Pts w hemodynamic instability who do not meet criteria for shock are labeled as pre-shock
Management algorithm for patients with or at risk for cardiogenic shock (CS) tailored to the Society for Cardiovascular Angiography and Intervention (SCAI) Shock stage
Framework of clinical parameters to follow in patients with heart failure-related cardiogenic shock in the critical care unit
Considerations for invasive hemodynamic assessment in HF-CS
It seems that the most controversial issue is the use of short-term mechanical circulatory support for cardiogenic shock. So, a very recent publication deals with this:
Proposed overview of selection of patients to pVAD based on SCAI shock class A-E
Flowchart to identify and handle potential need for escalation of mechanical circulatory support in patients supported by axial flow pump (AFP)
Flowchart to identify and handle potential need for venting during V-A ECMO support
• • •
Missing some Tweet in this thread? You can try to
force a refresh
Is there anything regarding UGIB that has not been already done, studied or tweeted about? Not much, but all of the following are things I witnessed happening (or not happening…) in two UGIB cases I recently saw in the ICU
Here it begins:
1. If a patient does not have an obvious UGIB as in the clip above, she has just presented with melena & it is still unclear if this is due to upper or lower GIB, a quick & dirty trick is to check the blood urea nitrogen/creatinine (BUN/creat) ratio. There are various published
cut-offs in the literature (don’t sweat about them…) but, in general, a ratio of >30 suggests UGIB. This is due to the small bowel absorption/digestion of blood protein which is subsequently metabolized to urea. There are confounding factors, but the trick usually works well
Walking from room to room in the ICU on a Sunday morning while hoping to have a quiet shift, you notice this 👇 on a patient's monitor (60 yo, admitted, intubated for COPD exacerbation + pneumonia 3 days ago, now sedated/hemodynamically stable)
It's unfortunately hard to pretend you didn't see it, so you get an ECG praying that it will not show what you saw on the monitor... 😊
Of note, admission ECG was "ok"
Well, it actually looks more impressive on the 12-lead ECG:
Is there anything about "lines" that has not been done or studied already? Not much, I guess, so these actually are not secrets, just things I had to do the last couple of weeks & hopefully you also find useful in your practice
Here it begins:
1. "Twin lines"
in the same vessel, if there is anatomical reason/venous thrombosis etc that limits the available options. I have even placed a 3rd line (Swan sheath) in the RIJ at the same time but the more of venous real estate is occupied by catheter lumens,
the higher the risk of venous thrombosis
Regarding the technical part of the procedure: I find it easier to place all the wires first & then railroad the catheters over them. This decreases the risk of puncturing the first catheter when trying to locate the vein for the second