Hemodynamics Management

Epinephrine in Out-of-Hospital Cardiac Arrest

A Network Meta-analysis and Subgroup Analyses of Shockable and Nonshockable Rhythms

Standard-dose epinephrine, high-dose epinephrine, and the combination of epinephrine with vasopressin are associated with increased ROSC and survival to hospital admission post-OHCA compared to placebo or no treatment. However, these agents don't necessarily enhance survival to discharge or ensure a good functional outcome. Notably, standard-dose epinephrine does improve survival to discharge for patients with a nonshockable rhythm but not for those with a shockable rhythm.

Epinephrine in Out-of-Hospital Cardiac Arrest - CHEST (chestnet.org)

Timing of Vasopressin Addition to Norepinephrine and Efficacy Outcomes in Patients With Septic Shock

This retrospective study is aimed to determine whether the timing of adding vasopressin to norepinephrine affects the resolution of shock in patients with septic shock. The study analyzed a total of 243 patients and divided them into two groups: early vasopressin addition (<3 hours) and late vasopressin addition (≥3 hours). The primary outcome measured was the time to shock resolution, defined as being free from vasopressors for at least 24 hours. The study found that the early addition of vasopressin resulted in a statistically significant decrease in the time to shock resolution compared to the late addition group. The early addition of vasopressin did not affect norepinephrine dose or in-hospital mortality but did lead to a decreased length of stay in the intensive care unit (ICU).

Perspective: This study contributes to the existing knowledge on the…

"Does Early ECMO Therapy Influence Survival in Cardiogenic Shock? An Analysis of Recent Findings"

A randomized Czech Republic trial has recently examined the impact of immediate versus delayed or no venoarterial extracorporeal membrane oxygenation (VA-ECMO) therapy in patients with severe or rapidly worsening cardiogenic shock. Although VA-ECMO can swiftly stabilize hemodynamics in such cases, its definitive impact on survival remains ambiguous.

Patients in the study had predominantly ST-segment–elevation myocardial infarction (50%) or decompensated heart failure (23%). A total of 117 patients, median age 66, were observed over eight years. They found that the incidence of the composite primary end point (death, resuscitated circulatory arrest, and the use of another mechanical circulatory support, including ECMO in conservative-care group) at 30 days did not significantly differ between the immediate ECMO group and the conservative-care group. The mortality rate was also comparable in both groups, and serious adverse events were similarly frequent.

These…

The use of mechanical ventilation in hypovolemic conditions leads to various physiologic effects. The right ventricular preload decreases due to the compression of the superior vena cava and an increase in intramural right atrial pressure, causing a decrease in transmural right atrial pressure. In West zones I and II, pulmonary capillaries are compressed, leading to an increase in right ventricular afterload. In West zone III, the increase in alveolar pressure pushes blood from the capillaries towards the left side of the heart. Additionally, there is a decrease in left ventricular afterload due to an increase in pleural pressure. The abbreviations used in the text include LA for left atrium, LV for left ventricle, Palv for alveolar pressure, Ppl for pleural pressure, RA for right atrium, and RV for right ventricle.