Steady Eddy: Case Study of Patient on Temporary Device
Transcript of Steady Eddy: Case Study of Patient on Temporary Device
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Steady Eddy: Case Study of Patient on Temporary Device
Joseph C. Cleveland, Jr., MDFrederick and Carol Grover Endowed Chair in Surgery
Surgical Director, Cardiothoracic TransplantationUniversity of Colorado Anschutz Medical Center
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Disclosures• Co-PI, MOMENTUM 3 Trial, Abbott Laboratories
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Cardiogenic Shock• 35 Year Old Male
• 6 week history of progressive SOB• No Past Medical History• Admitted to MICU when could no longer walk more than 10 feet• Exam: Vitals 80/65, HR 120,
• Cold, Clammy extremities.• 3/6 Systolic Murmur
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Clinical Course• Admission to Cardiac ICU
• Vitals: HR 110-120, BP 80-09/60• Labs: Lactate 4.0, Creatinine 1.6, AST/ALT 1300/1700• Right Heart Cath: RA 21, PA 63/37, PCWP 30, CO 2.8, CI 1.5• Urine Output 10 cc/hr.• Started on Dobutamine (7.5 ug/kg/min) and Milrinone (.375 mcg/kg/min)
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Question -ARS• This patient is in cardiogenic shock
• True• False
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Question• Optimal Treatment at this point in his course is:
• A.) Continue current therapy - inotropes and hope for recovery• B.) Temporary Mechanical Circulatory Support• C.) Emergent Placement of a Durable LVAD• D.) Palliative Care
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Temporary Support Devices - IABP
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Temporary Support Devices – VA ECMO
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Temporary Support Devices – Impella
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Temporary Support Devices – Tandem Heart
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Temporary Support Device - RP Impella
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Patient Course• Patient underwent Temporary Mechanical Circulatory Support with
VA ECMO• Cardiac Transplant Evaluation initiated• Transplanted Successfully on Hospital Day 8
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INTERMACS 3 Definition - Coding
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Summary• Stabilization of patients in cardiogenic shock with temporary
mechanical circulatory support will increase• Variety of devices now exist for stabilization/strategy to buy time and
assess what is best for the patient