Team Approach to the Management of Shock Part 2

Jeffrey Marbach, MD, an interventional cardiologist and cardiac critical care fellow at Tufts Medical Center in Boston, opens this portion of the TAMS event by presenting the first case. The patient is a 72-year-old patient with anterior STEMI who developed VF arrest during PCI. Due to cardiogenic shock, Impella CP® heart pump was placed and the patient was transferred to Tufts for further management.

Haval Chweich, MD, a CCU intensivist pulmonary and critical care attending physician at Tufts Medical Center, offers the case of a 71-year-old patient presenting to an outside hospital with chest pain. The patient was placed on intra-aortic balloon pump (IABP) and transferred to Tufts Medical Center for surgical consult. Overnight, he was overactive and pulled out the balloon pump and his condition deteriorated. At this point, Dr. Chweich notes that potential next steps were inotropes, IABP, Impella CP, or ECMO.

Dr. Marbach presents a second case, this time a 49-year-old patient with heart failure shock, which has different hemodynamic and hemometabolic profiles than AMI shock. This patient had been decompensating and came in for a right heart cath and evaluation for transplant. Dr. Marbach emphasizes that recent data supports the use of PA catheters in shock patients and he mentions a 2020 paper by Garan et al. from J Am Coll Cardiol HF showing that across all SCAI stages, patients with complete hemodynamic profiling have lower overall mortality.

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