Left ventricular energetics in patients receiving veno-arterial extracorporeal membrane oxygenation for extracorporeal cardiopulmonary resuscitation The haemodynamic effects veno-arterial extracorporeal membrane oxygenation (VA-ECMO) remain inadequately understood. We investigated invasive left ventricular (LV) haemodynamics in patients who underw...

Similar to what the Minnesota group found, right? www.resuscitationjournal.com/article/S030...

Again try avoid CPRing if possible so low end and say 20 which feels right.

When I ask Open Evidence to use the old Swan studies to give an average stroke volume for patients with septic shock and severe heart failure it gives average of 60-80 mL and 40-60 mL respectively so let’s take that at face value and rate you would need to generate that would be 15-30.

Assuming your only possible intervention immediately is CPR I think it turns into a math problem. Exact CO of CPR not known but about 30% pre-arrest output. Since not technically dead and don’t want to compress unnecessarily let’s give benefit of doubt and say CO of CPR is max 1200 mL (30% of 4 L).

Pulmonary artery catheter: does the problem lie in the users? - PubMed The aims of this study were to look for the variability in the treatment of circulatory shock and to assess the extent to which this variability was reduced by pulmonary artery catheterization (PAC). At three international conferences in 1997-1998 (European Society of Critical Care Medicine, French …

That one might be worse because you don’t know what it should be and some plurality to majority don’t know what it means

pubmed.ncbi.nlm.nih.gov/12065369/

If you take patients in shock and take out the ones who definitely need an arterial line is there a mortality benefit to only putting them in the ones who maybe need it? Does it help that no one really knows what number you want that arterial line to more accurately show?

What difference would there be between a profoundly vasoplegic patient with poor venous return or a patient with a poorly visualized and nearly akinetic right ventricle and the hypovolemic patient?

Something that has never made sense to me, if objective measures of end-diastolic area have not worked out as good predictors of recruitable cardiac output then why would there be any validity in saying “meh looks a little empty”?

I think the best feature of EPIC is that the urine output is yellow. Something intensely satisfying about it

So what happens when it’s indefinitely trended?

Good point, but I would typically think of these as significant variation over minutes to hours rather than significant swings across seconds

#emimcc #medsky

You are basically left with some cause of significant (LV) preload variability: cardiac tamponade, large shunt, significant hypovolemia. What else is missing, either mechanistically or clinically? @pulmcrit.bsky.social @load-dependent.bsky.social @zentensivist.bsky.social

Thoughts on the differential for a patient with extreme hemodynamic lability (I.e. excessive MAP swings with vasopressor titration)? As a thought exercise it seems, after eliminating practicalities like measurement error, ineffective delivery, etc.