Table 2 Escalation to tMCS in HF-CS
From: The management of heart failure cardiogenic shock: an international RAND appropriateness panel
Statements | Median | Disagreement index (DI) | Inter-percentile range (IPR) | RAND panel outcome |
|---|---|---|---|---|
Regarding the use of clinical, biochemical and haemodynamic parameters to guide escalation to tMCS in the context of maximal or optimal pharmacotherapy, please rate the appropriateness of the following: | ||||
Failure to achieve adequate diuresis/clinical decongestion | 7.5 | 0.16 | 1.25 | Appropriate |
Lactate clearance | 8.0 | 0.07 | 1.25 | Appropriate |
Serial worsening of liver function tests (bilirubin, transaminases & INR) | 7.5 | 0.16 | 1.25 | Appropriate |
Serial worsening of renal function (urine output, creatinine, eGFR) | 7.0 | 0.26 | 2.00 | Appropriate |
Serial worsening of central venous oxygen saturations (ScVO2) | 7.0 | 0.26 | 2.00 | Appropriate |
PAC haemodynamic data to inform escalation decisions | 7.5 | 0.43 | 3.00 | Appropriate |
PAC haemodynamic data to inform device selection | 8.0 | 0.23 | 2.25 | Appropriate |
Specific PAC thresholds (informed by AHA guidance [41], Geller et al. [42]) to inform escalation decisions | 4.5 | 0.55 | 2.25 | Uncertain |
Echocardiographic parameters to guide escalation decisions | 6 | 0.43 | 2.25 | Uncertain |
Echocardiographic parameters to guide device selection | 7 | 0.37 | 2.25 | Appropriate |
Regarding the selection of tMCS in the management of SCAI Stage C HF-CS, please rate the appropriateness of the following: | ||||
IABP as a tMCS option for bridge to recovery or durable therapies | 5.5 | 0.71 | 3.00 | Uncertain |
Impellaâ„¢ CP as a tMCS option for bridge to recovery or candidacy for durable HF therapies | 5.0 | 0.55 | 2.25 | Uncertain |
Impellaâ„¢ 5.0/5.5 as a tMCS option for bridge to recovery or candidacy for AHF therapies | 7.0 | 0.21 | 1.25 | Appropriate |
Routine mechanical LV decompression in the context of peripheral VA ECMO | 6.5 | 0.59 | 3.25 | Appropriate |
Optimised pharmacological LV decompression prior to mechanical LV decompression | 7.0 | 0.37 | 2.00 | Appropriate |
IABP as a mechanical LV decompression strategy in peripheral V-A ECMO | 5.5 | 0.32 | 1.25 | Uncertain |
Impellaâ„¢ (CP/5.0/5.5) as a mechanical LV decompression strategy in peripheral V-A ECMO | 6.5 | 0.30 | 2.00 | Appropriate |