A 50-year-old man on ICU develops cardiogenic shock from a massive anterior STEMI. The interventional cardiology team has performed primary PCI. He re...

Question

A 50-year-old man on ICU develops cardiogenic shock from a massive anterior STEMI. The interventional cardiology team has performed primary PCI. He remains shocked. The team measures lactate: 8 mmol/L at baseline, rising to 12 mmol/L at 6 hours despite dobutamine and IABP. What does a rising lactate despite mechanical support indicate?

Accepted Answer

Progressive tissue hypoperfusion despite current support - indicating inadequate cardiac output, suggesting the need for escalation of mechanical support (e.g. Impella or VA-ECMO) or consideration of advanced HF therapies

Answer

The lactate measurement is inaccurate

Answer

Lactate always rises in ICU - it is not clinically significant

Answer

The IABP is working too well

Answer

Lactate is produced by the IABP device

uk-fficm MCQ (SBA): Cardiogenic Shock - Rising Lactate