SCCM Resource Library-September Journal Club: Spotlight on Pharmacy (2025)

Video Transcription

Video Summary

This Journal Club Spotlight webcast featured presentations by three critical care pharmacy residents on recent clinical studies. <br /><br />Anna Piotrowicz discussed a randomized controlled trial examining adjunctive milrinone versus placebo to improve cardiac output in septic shock patients with poor tissue perfusion despite resuscitation. The study found that milrinone significantly increased cardiac output at six hours compared to placebo, but did not improve mortality or secondary clinical outcomes. Limitations include small sample size, lack of milrinone titration, and differences in baseline cardiac function. Milrinone’s vasodilatory effects in vasodilatory shock and its unclear impact on mortality temper enthusiasm for routine use.<br /><br />Samuel Yang reviewed a retrospective study comparing tris-hydroxymethyl aminomethane (THAM) versus sodium bicarbonate for treating metabolic acidosis after cardiopulmonary bypass surgery. THAM improved pH and mean arterial pressure without causing hypernatremia, hypercarbia, or hyperkalemia. However, patients receiving THAM were generally sicker and also received bicarbonate, confounding results. THAM’s high cost and limited availability justify stewardship and further research to clarify clinical benefits beyond pH correction.<br /><br />Corey Gallrapp presented the ANGEL-TNK randomized trial assessing intra-arterial tenecteplase after successful endovascular thrombectomy for acute ischemic stroke. Treatment improved excellent neurologic outcomes (mRS 0-1 at 90 days) without increased bleeding or mortality. Limitations include strict inclusion excluding prior IV thrombolysis or antithrombotics, single-ethnicity population, and lack of secondary endpoint improvements. Results suggest potential benefit in select patients but call for further trials to confirm efficacy, safety, dosing, and generalizability.<br /><br />Overall, these studies provide insights into adjunctive therapies in critical care but highlight the need for larger, more pragmatic trials to assess meaningful patient-centered outcomes before changing practice.

Asset Subtitle

Sepsis, Cardiovascular, Neuroscience, 2025

Meta Tag

Content Type Webcast

Knowledge Area Sepsis

Knowledge Area Cardiovascular

Knowledge Area Neuroscience

Membership Level Associate

Membership Level Professional

Membership Level Select

Tag Shock

Tag Cerebral Ischemia

Year 2025

Keywords

Webcast

Sepsis

Cardiovascular

Neuroscience

Shock

Cerebral Ischemia

2025

Associate

Professional

Select

milrinone

septic shock

cardiac output

THAM

metabolic acidosis

cardiopulmonary bypass

tenecteplase

acute ischemic stroke

endovascular thrombectomy

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