Related Experiment Video
Updated: Oct 12, 2025
06:10
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
3.4K
Contemporary Management of Cardiogenic Shock: A RAND Appropriateness Panel Approach
Alastair G Proudfoot1,2,3,4, Antonis Kalakoutas4, Susanna Meade5
1Perioperative Medicine Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (A.G.P., M.J.D.G.).
Circulation. Heart Failure
|November 22, 2021
Summary
Expert consensus on cardiogenic shock care shows alignment with guidelines, but identifies uncertainties in fluid administration and mechanical support, underscoring the need for more randomized trials in managing this critical condition.
Area of Science:
- Cardiology
- Critical Care Medicine
- Clinical Practice Guidelines
Background:
- Current cardiogenic shock management relies on expert opinion and guidelines due to limited high-quality randomized trial data.
- An international panel aimed to identify areas of uncertainty in optimal patient management for cardiogenic shock.
Purpose of the Study:
- To determine expert consensus on various aspects of cardiogenic shock patient care.
- To identify specific areas of uncertainty in current cardiogenic shock management practices.
Main Methods:
- A modified Delphi process involving an 18-person multidisciplinary international expert panel.
- A RAND/UCLA appropriateness methodology survey with iterative rating of 70 statements on a 1-9 scale.
- Anonymous surveys followed by group discussions and re-surveys to reach consensus.
Main Results:
- Broad agreement was found with existing international guidelines and consensus statements.
- 44 statements were rated appropriate, 19 uncertain, and 7 inappropriate, with no significant disagreement.
- Routine fluid administration was deemed inappropriate; uncertainties included pre-PCI interventions, right heart catheterization, LV unloading, and futility markers for mechanical support.
Conclusions:
- Expert consensus largely aligns with current cardiogenic shock guidelines.
- Significant clinical equipoise exists in several key areas of cardiogenic shock management.
- Further randomized controlled trials are crucial to guide optimal patient management and decision-making in cardiogenic shock.
Related Concept Videos
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
111
Pharmacologic intervention is crucial in treating cardiac arrest patients during ACLS or Advanced Cardiovascular Life Support. The ACLS algorithms guide the administration of specific drugs based on the patient's cardiac arrest rhythm, which includes pulseless ventricular tachycardia (VT), ventricular fibrillation (VF), asystole, and pulseless electrical activity (PEA).EpinephrineIndication: Epinephrine is the first-line drug for all cardiac arrest rhythms.Mechanism of Action: Epinephrine...
111
01:28Acute Coronary Syndrome IV: Interprofessional Care
48
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
48
01:30Heart Failure V: Medical Management
47
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
47
01:26Acute Coronary Syndrome V: Nursing Management
62
Nursing Assessment:Nursing management of acute coronary syndrome (ACS) involves taking the patient's history, focusing on primary complaints such as chest pain, dyspnea, and excessive sweating (diaphoresis), as well as other symptoms like back or jaw pain, nausea, vomiting, palpitations, dizziness, and fatigue. The nurse also reviews the patient's history of cardiac events, risk factors such as hypertension, diabetes, smoking, family history, and current medications.In the objective assessment,...
62
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
561
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
561
01:26Angina IV: Management
45
IntroductionThe management of angina requires a comprehensive approach that includes pharmacological therapies, medical procedures, and lifestyle modifications.Pharmacological TherapiesAntiplatelet agents, such as aspirin, clopidogrel, prasugrel, and ticagrelor, play a pivotal role in preventing thrombus formation in patients with angina. These medications inhibit platelet aggregation and reduce the likelihood of myocardial infarction and other cardiovascular events.Anticoagulants, including...
45