Hemodynamics Management

This screenshot you provided shows the monitor of an Impella CP which appears to be positioned in the aorta instead of the correct position within the left ventricle (LV).

• Ao Pressure: 126/73 mmHg (Mean 93 mmHg), indicating the device is picking up aortic pressure signals.

• LV Pressure: There is a loss of clear pressure signals from the left ventricle, which would normally be used to monitor proper positioning.

• The low fluctuation of the motor current, (with readings showing a current of 399/350 mA), suggests that there is minimal pressure gradient across the two pressure sensors of the Impella device. These sensors normally detect pressure differences between the aorta and the left ventricle.

The motor current stability (almost flat) suggests that the Impella is likely not in the left ventricle (as intended) but rather in the aorta. Since both sensors are exposed to aortic pressure, there is little to no pressure gradient detected…

23 years old male with mental status changes, tachycardia and suppressed TSH level.

DanGer Shock Trial

Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock | New England Journal of Medicine (nejm.org)

Use and Outcomes of Peripheral Vasopressors in Early Sepsis-Induced Hypotension Across Michigan Hospitals - CHEST (chestnet.org)

Cardiogenic Shock Intravascular Cooling Trial (CHILL-SHOCK) - Journal of Cardiac Failure (onlinejcf.com)

Post cardiac arrest, CPR 15 min , ROSC achieved

VExUS for evaluation of venous congestion in a patient with mixed cardiogenic and distributive shock, acute respiratory failure, bibasilar infiltrates, and acute kidney injury.

Step 1: IVC diameter is 2.5 cm

Step 2: hepatic vein doppler assessment showing reversal of the systolic wave.

Step 3: Portal vein doppler assessment showing more than 50% variability

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