This handout is for cardiogenic shock — scai stage e (extremis / refractory). Your care team identified this based on: cardiac arrest with ongoing cpr — consider ecpr per arrest trial criteria.
Other reasons your team may use this plan: map <60 + lactate ≥6 + multi-organ failure on mcs + max pharmacology — e-stage extremis; cs-related arrest with rosc but persistent extremis — e-stage post-arrest.
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| norepinephrine | 0.5-3.0 mcg/kg/min IV (typical E-stage doses) | IV | continuous | Maintained on max dose during ECMO bridge to recovery or destination |
| epinephrine | 0.05-0.5 mcg/kg/min IV | IV | continuous | Adjunct when NE max + vasopressin inadequate; inotropic + chronotropic at higher doses |
| vasopressin | 0.03-0.06 U/min IV | IV | continuous | V1 adjunct on max NE; often needed at E-stage |
| amiodarone | 150 mg IV bolus then 1 mg/min × 6h then 0.5 mg/min × 18h | IV | continuous | AHA ACLS Class IIb; preferred during ECPR if VF/VT-arrest etiology |
| heparin | ECMO circuit anticoagulation per protocol; aPTT 60-80 | IV | continuous | Mandatory on VA-ECMO to prevent circuit thrombosis; bleeding risk balance |
Plan: SCAI E extremis regimen — VA-ECMO + max pharmacology + LV venting; futility cadence
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Futility discussion at 24-72h; ethics consult if no recovery; bridge to durable LVAD or transplant if eligible; palliative if not
Guideline: SCAI 2022 CS staging + AHA 2020 ACLS + 2025 ACC/AHA ACS