PiCCO Cardiogenic Shock — FRCA Final MCQ

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HardIntensive Care MedicinePiCCO Cardiogenic ShockFRCA Final

A 58-year-old man in ICU has a PiCCO monitor showing: CI 2.2 L/min/m², SVRI 2800 dynes.s.cm⁻⁵/m², GEDVI 850 mL/m², EVLWI 12 mL/kg. What haemodynamic pattern does this represent?

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Correct answer: A — Cardiogenic shock

The PiCCO data shows: low cardiac index (CI <2.5), high systemic vascular resistance (SVRI >2000), elevated preload (GEDVI >800 – suggesting adequate/high filling), and elevated extravascular lung water (EVLWI >10 – pulmonary oedema). This pattern indicates cardiogenic shock: the heart is failing (low CI) with compensatory vasoconstriction (high SVRI), volume overload (high GEDVI), and resultant pulmonary oedema (high EVLWI). Management: inotropes (dobutamine/milrinone), diuretics, and potentially mechanical support.

Reference: RCOA – 2023 – ICM curriculum: advanced haemodynamic monitoring; ICS – 2023 – Haemodynamic monitoring