Milrinone or Dobutamine for Cardiogenic Shock?

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Hemodynamic management of patients with cardiogenic shock centers on vasopressors, inotropes, and mechanical circulatory devices.  With respect to inotropic medications, there is little data to guide optimal management and selection of agents.  In this podcast we discuss the results of a recent trial that compared milrinone with dobutamine for patients with cardiogenic shock.  Which agent was the winner?

The TOMAHAWK Study

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The COACT trial demonstrated no improvement in 90-day mortality for post-arrest patients without evidence of an ST-segment elevation MI who were randomized to immediate or delayed coronary angiography.  However, the COACT Trial included only OHCA with a shockable rhythm and overall had a very low number of patients that had an acute thrombus at the time of angiography.  In this …

The BaSICS Trial – Implications for Fluid Resuscitation

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The administration of IVFs is nearly universal in critically ill patients.  In recent years, several studies have suggested improved outcomes with the use of balanced crystalloids solutions in contrast to 0.9% NS.  In this podcast, we discuss the recently published BaSICS Trial that evaluated Plasma-Lyte 148 with 0.9% NS in critically ill patients.  Does this study provide practice-changing evidence to …

The TTM2 Trial

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Current international guidelines recommend TTM for adult patients with ROSC from OHCA who remain comatose or unable to follow verbal commands.  However, the overall level of evidence for this recommendation remains of low certainty.  In this podcast, we discuss the results of the recently published TTM2 Trial and its implications on the management of post-cardiac arrest patients.

ECMO for Cardiac Arrest and Massive PE

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Despite continued advances in resuscitation, favorable outcomes for patients with OHCA who receive standard resuscitation remain dismal.  In recent years there has been significant interest in the use of ECMO for OHCA.  However, the evidence demonstrating the efficacy of ECMO in OHCA remains limited.  In this podcast we review the recent ARREST Trial, which evaluated ECMO-facilitated resuscitation in OHCA.  In …

The HOT-ICU Study

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Critically ill patients with acute hypoxic respiratory failure receive supplemental oxygen as a component of their treatment.  In recent years, exposure to high levels of FiO2 with resultant “hyperoxia” have been associated with increased mortality in critically ill patients.  At present, there is no clinical practice guideline on oxygenation targets for adult patients with hypoxic respiratory failure.  In this podcast, we discuss the …