#cccsky — Public Fediverse posts

RCTs have shown no benefit from IABP in acute ischemic cardiogenic shock, an observatiobal trial isn’t even hypothesis generating. No grounds for new IABP trials in this population in my opinion. #cardiosky #cccsky #emimcc

Intra-aortic balloon pump vers...

Bayesian reanalysis can be a great way to assess a contested trial, by showing how strong a prior you need to nullify or inverse the results. I don't understand why they did not include a pessimistic prior here though (even as I see a sceptical one more realistic). #emimcc #cardiosky #cccsky #stats

RE: https://bsky.app/profile/did:plc:77cp7kgakti2uthqnkkdaqum/post/3mkpw474mis2q

In a patient with high-risk pulmonary embolism, but no sign of hypoperfusion, would you start LMWH or UFH? #emimcc #cardisky #cccsky #critcaresky

This should be the death of Impella outside of severe cardiogenic shock. High probability it increases mortality. #cardiosky #cccsky

RE: https://bsky.app/profile/did:plc:yrhfut7mmcbabz6mgjqcyums/post/3mi7xwmgjrs2k

Can we please stop referring to lactate as a perfusion marker? It’s no more so and no better than blood pressure. #emimcc #cccsky

One point that isn't mentioned here but too often forgotten when noradrenaline seemingly isn't working: Are you actually using a representative blood pressure? Not so rare that a better (more central or better line) fixes the problem. Look at the whole patient, not just a number! #emimcc #cccsky

RE: https://bsky.app/profile/did:plc:vmwckmxogx3lipqxlmn76mbe/post/3mh67jqfw3z2h

Can't wrap my head around how this is even possible! TAVI in mechanical valves. #cardiosky #cccsky academic.oup.com/eurheartj/ad...

Transcatheter aortic valve-in-...

What is worse, digital ischemia or atrial fibrillation? #emimcc #cccsky link.springer.com/article/10.1...

Vasopressin in septic shock: a...

To write a "state-of-the-art review" of diastolic dysfunction in acute and critical illness with an emphasis on SGLT2-inhibition and not mention the DEFENDER trial is quite something. #cardisky #emimcc #cccsky www.jacc.org/doi/10.1016/...

Diastolic Dysfunction in Acute...

Truth #echosky #cccsky #cardiosky

RE: https://bsky.app/profile/did:plc:otftpifioqccvzcrpvj7fe3l/post/3md6fun3crc2i

#cardiosky #emimcc #cccsky

Excellent review of CVP measurement. #emimcc #cccsky #cardiosky www.sciencedirect.com/science/arti...

RE: https://bsky.app/profile/did:plc:m5k3kf3obaxscbxm2hhsuzr6/post/3mbqosjmsys22

Right Atrial Pressure in the C...

Does anyone have a good paper on pearls and pitfalls of CVP measurements? #emimcc #cccsky

Levosimendan is quite often seen as a "safe" inodilator with respect to ventricular arrhythmias. I don't think it is, and this trial in my view supports that. Also, drugs with very long half lives are generally not a good idea in the critically ill #cardiosky #emimcc #cccsky

Levosimendan to Facilitate Wea...

New results from DanGer Shock ,shows it's those with the lower systolic pressure (the sicker patients) that benefit from Impella. #emimcc #cardiosky #cccsky jamanetwork.com/journals/jam...

I’m reading up on the risk of increased intrapulmonary shunting and hypoxia posed by nitroprusside, and thinking, should this not also apply to other vasodilators like nitroglycerine and milrinone? Can only see it described for nitroprusside #emimcc #cccsky

One of my strong pet peeves: never start vasopressin based on a fixed cutoff for noradrenaline and never without an echo. I strongly oppose the algorithm proposed here #emimcc #cccsky

RE: https://bsky.app/profile/did:plc:oaaejshh5ta7u2zzmczevuyi/post/3m5hfnacyps2y

Likewise, low blood pressure is a reliable sign of shock and malperfusion in sepsis/distributive shock, but not in other, especially cardiogenic shock. #emimcc #cccsky

RE: https://bsky.app/profile/did:plc:kgfqlfzek5twmq7ahzc5ws46/post/3m2pk6yahlk23

#emimcc #cccsky

#emimcc #cccsky

Finally some good evidence for whether DOACs can be effective in treatment of left ventricular thrombus. Is this generalisable to all DOACs? #cardiosky #cccsky www.jacc.org/doi/10.1016/...

Rivaroxaban vs Warfarin in Acu...

Granted, few patients where still available after 4 years, but still odd to have 0 mortality from 4 to 10 years in a population that has had cardiogneic shock #cccsky #cardiosky #emimcc

RE: https://bsky.app/profile/did:plc:pqur3apsmhyw756zvruofulp/post/3lxp2qv4ttc2c

#cccsky

Extremely striking difference in utilisation of Impella in the US vs UK and Canada. #cardiosky #cccsky #emimcc jamanetwork.com/journals/jam...

Great thread! The one thing I will disagree on is the value of EF. It is misused and misunderstood but far from useless. It is a measure of ventriculoarterial coupling and used in conjunction with stroke volume truly informstive of the balamce between LV function and afterload. #emimcc #cccsky

RE: https://bsky.app/profile/did:plc:pdj5upxe4ocjvjltlkdai7b4/post/3lwjyglqvrc2l

#cccsky

Absolutely fascinating! We know the heart switches to lactate as energy substrate in shock, could there be a clinical benefit from lactate infusion in human cardiogenic shock? #emimcc #cccsky

RE: https://bsky.app/profile/did:plc:gjh4hswdpahgwosaktvp6tx7/post/3lkt6cu357j2z

Is it reasonable to have the same empirical MAP target in cardiogenic and septic shock? It’s not really the MAP that matters but the perfusion pressure, and that means taking CVP into account. #emimcc #cccsky

I’m obviously a bit biased, but I believe there is greater danger in misclassification of non-septic shock (especially cardiogenic) as septic shock than from delayed recognition of septic shock. #emimcc #cccsky

Here’s a quiz: why would stroke volume increase by 100%, HR only slightly decrease yet blood pressure (i assume MAP) only increase 25%? #emimcc #cccsky #physiology

RE: https://bsky.app/profile/did:plc:pdj5upxe4ocjvjltlkdai7b4/post/3lktq4ctkhm2l