Managing Cardiogenic and Combined Shock in COVID Patients
This presentation by Dr. David A. Baran addresses the challenges and strategies in managing cardiogenic and combined shock in COVID patients. It covers COVID operations, status quo challenges, professional recommendations, and more in a concise and informative manner.
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Presentation Transcript
Managing Cardiogenic and Combined Shock in COVID Patients David A. Baran, MD, FACC, FSCAI, FHFSA System Director, Advanced Heart Failure, Transplant and MCS Sentara Heart Hospital Professor of Medicine Eastern Virginia Medical School, Norfolk, Virginia
Disclosures Consulting: Abiomed, Livanova, Abbott, M3, Aortrix, Getinge Research: Abbott Speaker: Novartis, Pfizer
Outline Outline COVID operations Challenges to status quo Professional society recommendations Strategies to manage Conclusions
COVID Explosion of the Literature Not all is worthy Pre-print does not equal NEJM Such an explosion makes it challenging to keep up!
COVID COVID Operations Operations
PPE PPE COVID PPE is extreme Head cover Eye cover (goggles / shield) N95 Mask or PAPR Impervious gown Booties 2 sets of gloves
Challenges to the Challenges to the Status Quo Status Quo
COVID COVID- -19: Shapeshifter 19: Shapeshifter Learning while we treat STEMI mimic Flu mimic Is it HF Exacerbation or the Rona Pulmonary Embolism: DVT or My Corona?
More Questions than Answers More Questions than Answers What to do if the patient need intubation What if the patient codes What if the patient needs an echo? TEE: Double the aerosol
Intubation Intubation
What if the Pt Needs an ECHO What if the Pt Needs an ECHO Echo Tech needs to be close to patient for TTE TEE is considered an aerosolizing procedure More focus on bedside ultrasound and avoiding TEE
Professional Society Documents Professional Society Documents
SCAI / ACC SCAI / ACC Full PPE Don t forego STEMI care Early intubation (if doubt, intubate PRIOR to lab)
COVID and the Shock Team: Practical COVID and the Shock Team: Practical Strategies Strategies Be prepared N95 etc Algorithms of shock care have not changed More calls for confusing pictures Distributive shock Pulmonary embolism ? ECMO
Called to Lab for Shock Called to Lab for Shock Lab call: Place all lines needed Worthwhile to stay in lab to assess response PA Catheter critically important Ultrasound /ECHO in lab Consideration of RV support Consideration of ECMO in lab
Called to ICU for Shock Called to ICU for Shock Gather as much data outside the room Enter room like a SWAT team Prepared, with plan, and equipment Runner outside room door Know the Limits of engagement
Called from Outside Hospital: COVID + Prioritize based on local environment Consider survival likelihood in COVID Era Consider landing spot based on local protocol for COVID pts Consider ECMO options based on data available Consider transfer to lab vs ICU bed
Ongoing Care of Shock Early involvement of palliative care Involve those locally with best COVID knowledge Issues to consider Anticoagulation Daily COVID labs Recognizing cytokine storm Recognizing late PE
Contribute Ongoing Registries which will help inform the science North American COVID MI Registry NACMI (Dr. Tim Henry / SCAI) ELSO Registry AHA GWTG
Conclusions COVID has effects on every area of the health care system and the world Shock Care is impacted but algorithms are fundamentally similar PPE impacts our performance, but we will adapt Learning about COVID is a work in progress New information continues to be released at a blistering pace No one person can know all of it Multi-disciplinary teams including critical care / pulmonary / anesthesiology and infectious disease are critical
