Episode 5: Cardiogenic shock and ECMO with Brendan Riordan

This podcast episode addresses the complexities of managing a patient with cardiogenic shock, focusing on the use of mechanical circulatory support. Brendan Riordan, a cardiothoracic critical care PA, joins the hosts to discuss a hypothetical case involving a 45-year-old male with a left main lesion. Riordan details the stepwise approach to escalating support, from initial norepinephrine administration and Impella CP placement to the decision-making process behind initiating VA ECMO for biventricular support. He explains VA ECMO settings, including flow targets based on BSA, and the importance of monitoring for complications like regional hypoxemia and limb ischemia, highlighting the necessity of preemptive anti-grade perfusion catheters. The conversation further explores weaning strategies, emphasizing echo-guided assessments and a protocolized approach to reduce support while monitoring LV function.