Note to me: I need to review this awesome podcast frequently. And also I need to carefully reread the additional resourcces Dr. Weingart provides us in the show notes:
In this post links to and excerpts from EMCrit 259 – Cardiogenic Shock — The Next Level & Mechanical Circulatory Support with Jenelle Badulak. November 13, 2019 by Scott Weingart, MD FCCM.*
*Scott Weingart, MD FCCM. EMCrit 259 – Cardiogenic Shock — The Next Level & Mechanical Circulatory Support with Jenelle Badulak. EMCrit Blog. Published on November 13, 2019. Accessed on August 1st 2021. Available at [https://emcrit.org/emcrit/cardiogenic-shock-2-mcs/ ].
All that follows is from the above article.
Our Special Guest
Jenelle Badulak, MD
Acting Assistant Professor of Emergency Medicine, UW Medici
Dr. Badulak is an emergency physician and intensivist caring for patients in the Cardiothoracic and Medical Intensive Care Units at the University of Washington Medical Center, and in the Trauma Surgical Intensive Care Unit and Emergency Department at Harborview Medical Center.
The above chart is from SCAI clinical expert consensus statement on the classification of cardiogenic shock [PubMed Abstract] [Full-Text HTML] [Full-Text PDF]. Catheter Cardiovasc Interv. 2019 Jul 1;94(1):29-37.
The chart below is also from SCAI clinical expert consensus statement on the classification of cardiogenic shock [PubMed Abstract] [Full-Text HTML] [Full-Text PDF]. Catheter Cardiovasc Interv. 2019 Jul 1;94(1):29-37.
How Should We Start Treatment in the EDWe could center this discussion about the SCAI paper that came out (attached) [in 2019]. A nice collaborative expert panel piece outlining a CS pyramid used quickly at the bedside in the ED, ICU, Cath Lab, etc to help us identify these patients and communicate how sick they are to quickly activate escalation of care. It’s gaining traction and it’s way more useful for us in the ED and ICU than INTERMACS.2) What are the temporary MCS devices out there and when do you decide to use them?: We could talk through an example algorithm that we use at UW, and many other institutions have developed something similar (attached screen shots from my online textbook corECMO in development).
Cardiogenic Shock CentersWhat is regionalized care for cardiogenic shock?: This is a super hot topic now, especially with rapidly expanding use of temporary MCS, and needing to rapidly transport patients to centers capable of implanting MCS. Many cities are developing cardiogenic shock hub and spoke models to make it faster and easier to ship these patients to tertiary centers for rescue with temporary MCS and definitive care with comprehensive advanced heart failure therapies. Often these patients are first recognized to be in bad CS in the ED and if your hospital has nothing but an IABP, I’d argue the best thing to do is ship them instead of admit them.