Arterial shock resus - it's all about myocardial perfusion A talk by Robbie Lendrum at TBS23

1. Arterial shock – Resuscitation:
its all about myocardial perfusion!
Dr Robbie Lendrum
Pre-Hospital Care Consultant - Barts Health NHS Trust, Royal London Hospital, London’s Air Ambulance
Cardiothoracic Anaesthetist, Intensivist – Barts Heart Centre at St. Bartholomew’s Hospital

4. Pressure
above
LVEDP

7. 52 53 54 55 56 57 58
0
25
50
75
100
125
Time Since Injury
mmHg
Systolic
Diastolic
55 60 65
0
25
50
75
100
125
150
Time Since Injury (min)
mmHg
Classic Case 3
Systolic
Diastolic
35 40 45 50 55 60 65
0
25
50
75
100
125
150
Time Since Injury (min)
mmHg
Arterial Case 4
Systolic
Diastolic
1.
2..
3.
4.
45 50 55 60 65
0
25
50
75
100
125
Time Since Injury (min)
mmHg
Systolic
Diastolic

10. 1154
Patients
497
Critical Care
Patients
160
Cardiovascular
Dysfunction
(CVD)
CVD
13% of total
population
32% of critical care
population

11. C
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t
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c
R
e
n
a
l
0
20
40
60
80
100
SOFA Domain
%
of
Deaths
Prevalence of Each Domain Failure
in Critical Care Deaths

12. A
d
m
i
s
s
i
o
n
D
1
D
2
D
3
D
4
D
5
D
6
D
7
D
8
D
9
D
1
0
D
1
1
D
1
2
D
1
3
D
1
4
D
1
5
D
1
6
D
1
7
D
1
8
D
1
9
D
2
0
D
2
1
D
2
2
D
2
3
D
2
4
D
2
5
D
2
6
D
2
7
D
2
8
0
20
40
60
80
Day
Percentatge
Prevalence of Cardiovascular
Dysfunction Amonst Critical Care Deaths

13. Exsanguination - PHRT
0 10 20 30 40 50 60
Injury to Thoracotomy
London's Air Ambulance
Response Time
Injury to
Traumatic Cardiac Arrest
Time (minutes)
TIMELINES (Updated)
13 (7 to 24) minutes
21 (16 to 26) minutes
22 (17 to 30) minutes

14. • EFA 43 mins
• P1 63/16 (21) mmHg

15. Interventional Opportunities

16. 0 5 10 15 20
Minutes

18. P-PRO Study

19. Reperfusion
Cardiac / Cerebral – Whole body

20. P1 107/63 (77) mmHg
P2 37/20 (23) mmHg

21. P1 101/57 (72) mmHg
P2 82/43 (59) mmHg

22. Fall from height
110 Feet/35 metres!

23. 0:00 0:15 0:30 0:45 1:00
Z1
REBOA
P-REBOA
Arrive
ED
0
25
50
75
100
125
IABP,
mmHg
4Fr 8Fr
disconnected upsize

24. 1:15 1:30 1:45 2:00 2:15 2:30
Balloon
Down
Balloon
Up
Z3
0
25
50
75
100
125
IABP,
mmHg

25. Future

27. @robbielendrum
robert.lendrum@nhs.net