Team Approach to the Management of Shock Part 4

In this Q&A session, Daniel Burkhoff, MD, Bartley Griffith, MD, Babar Basir, DO, and Benham Tehrani, MD, discuss loss of pulsatility, ECMO training, training for spoke hospitals, and the choice between Impella RP® and V-A ECMO.

Pedro Villablanca, MD, MSc, FACC, FSCAI, an interventional cardiologist and structural heart intervention specialist at Henry Ford Hospital, presents the case of a 52-year-old female presenting with chest pain and cardiac arrest. The patient went into complete heart block during PCI, and Impella CP® was inserted, but she developed limb ischemia. She was transferred directly to the cath lab at Henry Ford Hospital where a right heart cath revealed possible RV dysfunction with low CPO and low CI. The team evaluated the access options for escalation of support, determining that transcaval delivery of Impella 5.0® was the best option.

Michael Kiernan, MD, MS, MBA, medical director of the ventricular assist device program and assistant professor at Tufts University School of Medicine, presents the case of a 51-year-old male with acute decompensated heart failure and longstanding chronic kidney disease. He also had limited social support, which figured into later treatment decisions. He presented to an outside facility with deteriorating renal function and severely deranged hemodynamics. The patient was medically treated and discharged home on inotropic support with a planned referral to Tufts for consideration of heart/kidney transplant. He was readmitted with progressive dyspnea and edema.

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