Critical Care Scenarios Episode 5: Cardiogenic shock and ECMO with Brendan Riordan
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Mar 29, 2020 Brendan Riordan, a cardiothoracic critical care PA at the University of Washington, shares his expertise on managing cardiogenic shock. He discusses practical approaches to initiating and managing ECMO and Impella devices, focusing on achieving hemodynamic stability. Riordan dives into the complexities of heparin management, balancing bleeding risks and circuit longevity. He also offers insights into patient recovery monitoring and the intricacies of assessing hypoxia in patients on VA ECMO, highlighting the collaborative efforts needed in critical care.
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Initial Cardiogenic Shock Management
- Start cardiogenic shock management with pharmacological support like norepinephrine and consider inotropes cautiously.
- Use a percutaneous left ventricular assist device like Impella during PCI for ventricular support and oxygen demand reduction.
Combine VA ECMO and Impella
- For biventricular failure with poor LV response, initiate peripheral VA ECMO with femoral cannulation.
- Use the Impella simultaneously to unload the left ventricle and prevent distension during ECMO.
ECMO Initial Settings Guidance
- Calculate ECMO flow targets based on BSA times 2.0 to 2.4 L/min to ensure adequate cardiac output.
- Initiate ECMO with incremental pump speed increase over 1 to 5 minutes while monitoring for complications.