Hemodynamics Management

The Precision Resuscitation With Crystalloids in Sepsis (PRECISE) Trial: A Trial Protocol | Critical Care Medicine | JAMA Network Open | JAMA Network

The PRECISE trial aims to assess whether an electronic health record (EHR) alert recommending balanced crystalloids over normal saline for patients with group D sepsis reduces 30-day inpatient mortality. This pragmatic, randomized trial uses a machine learning algorithm to identify patients with a sepsis subphenotype (group D), previously shown to benefit from balanced crystalloids. The trial, conducted across multiple hospitals, could significantly influence sepsis resuscitation guidelines by introducing a precision medicine approach.

The group D sepsis sub-phenotype is characterized by lower body temperature, heart rate, and respiratory rate, along with hypotension. Patients in this group are typically older and show higher vasopressor use. Importantly, group D has a significantly higher 30-day mortality risk. However, in the SMART trial, group D patients experienced a substantial reduction in mortality when treated…

Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock (ECMO-CS) trial

• The ECMO-CS trial was conducted to compare the effects of immediate implementation of VA-ECMO vs. an initially conservative therapy in patients with rapidly deteriorating or severe cardiogenic shock.

• The primary endpoint was the composite of death from any cause, resuscitated circulatory arrest, and implementation of another mechanical circulatory support device at 30 days.

• A total of 122 patients were randomized, and 117 subjects were included in the analysis after excluding 5 patients due to the absence of informed consent.

• The composite primary endpoint occurred in 37 (63.8%) and 42 (71.2%) of patients in the immediate VA-ECMO and the no early VA-ECMO groups, respectively (hazard ratio, 0.72; 95% confidence intervals [CI], 0.46 to 1.12; P=0).

Efficacy of Levosimendan in the Treatment of Patients with Severe Septic Cardiomyopathy

www.jcvaonline.com

This study was designed to compare the effects of levosimendan and dobutamine on hemodynamics and clinical efficacy in patients with severe septic cardiomyopathy (left ventricular ejection fraction [LVEF] ≤35%).

•Thirty patients with severe septic cardiomyopathy were enrolled in the study and randomly divided into the levosimendan group and dobutamine group.

• The primary outcome was 28-day mortality.

• At the 24th hour after treatment, the CI, LVEF, SVI, and fluid volume were found to be higher in the levosimendan group than in the dobutamine group.

• On the third day of treatment, cardiac troponin I (cTnI) in the levosimendan group was lower than that in the dobutamine group.