Hemodynamics Management

The main factors, which influence ScvO2, are:

1. hemoglobin

2. Arterial oxygen saturation of hemoglobin

3. Cardiac output: CO

Propafenone versus amiodarone for supraventricular arrhythmias in septic shock: a randomised controlled trial

In a double-blind, two-centre trial involving 209 septic shock patients with new-onset arrhythmias, propafenone and amiodarone were compared for efficacy. Although 72.8% of patients on propafenone returned to sinus rhythm within 24 hours compared to 67.3% on amiodarone, the former achieved this in a median time of 3.7 hours, quicker than the 7.3 hours with amiodarone. Notably, propafenone-treated patients experienced fewer arrhythmia recurrences (52%) than those on amiodarone (76%). For those with a dilated left atrium, amiodarone showed superior rhythm control. In conclusion, while propafenone led to faster cardioversion and fewer recurrences, especially in patients with a non-dilated left atrium, both drugs demonstrated similar short- and long-term outcomes.

Propafenone versus amiodarone for supraventricular arrhythmias in septic shock: a randomised controlled trial | SpringerLink

ECLS-SHOCK trial investigated the effect of early extracorporeal life support (ECLS) on mortality in patients with heart attack-induced cardiogenic shock who were planned for early revascularization. Patients were assigned to ECLS plus medical treatment or medical treatment alone. After 30 days, mortality rates were similar between groups (ECLS: 47.8%, Control: 49.0%). ECLS patients had more bleeding (23.4% vs. 9.6%) and vascular complications (11.0% vs. 3.8%). ECLS didn't lower 30-day mortality in patients with infarct-related cardiogenic shock.

Extracorporeal Life Support in Infarct-Related Cardiogenic Shock | NEJM

Epinephrine in Out-of-Hospital Cardiac Arrest

A Network Meta-analysis and Subgroup Analyses of Shockable and Nonshockable Rhythms

Standard-dose epinephrine, high-dose epinephrine, and the combination of epinephrine with vasopressin are associated with increased ROSC and survival to hospital admission post-OHCA compared to placebo or no treatment. However, these agents don't necessarily enhance survival to discharge or ensure a good functional outcome. Notably, standard-dose epinephrine does improve survival to discharge for patients with a nonshockable rhythm but not for those with a shockable rhythm.

Timing of Vasopressin Addition to Norepinephrine and Efficacy Outcomes in Patients With Septic Shock

This retrospective study is aimed to determine whether the timing of adding vasopressin to norepinephrine affects the resolution of shock in patients with septic shock. The study analyzed a total of 243 patients and divided them into two groups: early vasopressin addition (<3 hours) and late vasopressin addition (≥3 hours). The primary outcome measured was the time to shock resolution, defined as being free from vasopressors for at least 24 hours. The study found that the early addition of vasopressin resulted in a statistically significant decrease in the time to shock resolution compared to the late addition group. The early addition of vasopressin did not affect norepinephrine dose or in-hospital mortality but did lead to a decreased length of stay in the intensive care unit (ICU).