Staggered use of sodium nitroprusside and levosimendan in a patient with refractory cardiogenic shock: a case report

Given the heterogeneous nature of CS and the various physiological derangements, several vasoactive medications may be attempted to try to stabilize or reverse the haemodynamic picture with or without the installation of MCS. These devices have evolved as novel treatment strategies to restore systemic perfusion to allow cardiac recovery in the short-term. But, this case demonstrates the potential of combining vasodilator and inotropic therapies-specifically dobutamine and milrinone with sodium nitroprusside and levosimendan-as a bridge strategy in severe CS when MCS is not feasible.