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The following is a summary of “Management of heart failure cardiogenic shock: an international RAND appropriateness panel,” published in the April 2024 issue of Critical Care by Williams et al.

Researchers conducted a prospective study identifying areas of agreement and disagreement in caring for patients with Heart Failure Cardiogenic Shock (HF-CS) admitted to critical care, aiming to inform current practice and future clinical trials.

They convened a 16-member multinational panel of experts. Employing a modified RAND/UCLA appropriateness method, they conducted a survey with 34 statements. Each participant anonymously rated the suitability of each statement on a scale of 1 to 9 (1–3 as inappropriate, 4–6 as uncertain, and 7–9 as appropriate).

The results showed 34 statements, 20 of which were deemed appropriate and 14 of which were considered inappropriate. Uncertainty prevailed across all three areas—initial assessment and management of HF-CS, transition to temporary Mechanical Circulatory Support (tMCS), and weaning from tMCS in HF-CS. Noteworthy disagreement among experts (indicated by a disagreement index surpassing 1) arose solely concerning the efficacy of thoracic ultrasound in immediate HF-CS management.

Investigators concluded that large-scale prospective studies were crucial to establishing best practices and future guidelines for HF-CS patients.

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-04884-5