The management of heart failure cardiogenic shock: an international RAND appropriateness panel

Table 1 The initial assessment and management of HF-CS

Statements	Median	Disagreement index (DI)	Inter-percentile range (IPR)	RAND panel outcome
Please rate the appropriateness of the following in the initial assessment and management of SCAI Stage C HF-CS:
Focussed Cardiac Ultrasound	9	0.13	1.00	Appropriate
Pulmonary artery catheter	6	0.51	2.00	Uncertain
Point of care thoracic ultrasound	5	1.27	4.00	Uncertain
Point of care Abdominal Ultrasound	3.5	0.35	2.25	Uncertain
Norepinephrine as 1^st line vasopressor	7	0.16	1.00	Appropriate
Dopamine as 1^st line vasopressor	3.5	0.51	2.25	Uncertain
Dobutamine as 1^st line inotrope	6.5	0.35	2.25	Appropriate
Milrinone as 1^st line inotrope	6	0.51	2.00	Uncertain
Shock team discussion in patients suitable for escalation to tMCS	8	0.29	2.00	Appropriate
Application of prognostic scoring tools e.g. IHVI and CardShock to inform management and escalation	4	0.51	2.00	Uncertain

For each question, median scores were allocated as inappropriate if scoring <3.5, uncertain if ≥3.5 and <6.5 uncertain and appropriate if ≥6.5. DI was calculated using the RAND DI and disagreement deemed if DI ≥1 amongst the panellists.
HF-CS, Heart Failure related Cardiogenic Shock; IHVI, Inova Heart and Vascular Institute; SCAI, The Society of Cardiovascular Angiography and Interventions; tMCS, temporary Mechanical Circulatory Support

ISSN: 1364-8535