Pharmacy to Dose: The Critical Care Podcast Vasopressor Clinical Pearls
Aug 20, 2025
Sean Chi, an emergency medicine pharmacist, shares insights on using vasopressors after cardiac arrest, discussing critical management strategies for hypotension. Eric Pham, a critical care pharmacy resident, presents the use of Midodrine for weaning vasopressors in sepsis and shock, highlighting its advantages and challenges. The conversation delves into the complexities of balancing pharmacological approaches with clinical outcomes, emphasizing the importance of tailored treatment plans for critically ill patients.
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Mixed Physiology Drives Post-ROSC Shock
- Post-ROSC shock is commonly mixed cardiogenic and distributive physiology due to myocardial injury and reperfusion vasoplegia.
- Preserving cerebral perfusion after ROSC is the primary hemodynamic goal to protect neurologic outcome.
ED Vignette: MAP 49 After ROSC
- Sean presents a vignette: a patient achieves ROSC with MAP 49 and hypotension immediately post-arrest.
- The scenario frames choosing how to restore perfusion and which vasopressor to use.
Prioritize MAP Over Vasopressor Brand
- Avoid hypotension after ROSC and target a MAP ≥65 mmHg to support cerebral perfusion.
- Use whichever vasopressor is fastest to start if logistics would otherwise delay achieving the MAP goal.