Brian Locke

Cardiogenic shock

Categorizing shock: alt

  • Preschock normotensive Hypoperfusion
  • Preshock hypotensive normoperfusion
  • LV-dominant
  • RV-dominant
  • Bi-V CS

Based on invasive hemodynamic parameters. Note: ESCAPE trial - decompensated HF - RCT with no benefit to RHC/Swan, however not in shock patients. Some subsequent retrospective data that does suggest a benefit.

Cardiac Power Output: MAP & CO / 451. The strongest correlate of mortality; 0.53W is the threshold, can be used to track response.

Pulmonary Artery Pulsatility Index: [PAS - PAD] / [CVP or RAP]. If PA Capacitance and CPWP is constant, it's a proxy for the Frank-Starling relationship. Studied mostly who will need RV support when getting LVAD

Shock Stages:

  • E: extremis
  • D: deteriorating/Doom - c, but not responding
  • C: Classic cardiogenic shock - hypotension
  • B: beginning cardiogenic shock - relative hypotension or compensatory tachycardia without hypo perfusion.
  • A: pre-shock/ at risk

Shock team approach? Maybe earlier/more MCS in pre-post

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