Clinical Pearls

Cardiogenic shock can lead to marked morbidity and even death. Race has been identified as a factor affecting outcomes in Black patients with acute myocardial infarction, but its impact on cardiogenic shock outcomes is unclear.Issa and colleagues compared the impact of self-identified race on cardiogenic shock outcomes in 3 patient groups: White, Black, and other. They found that Black patients had longer hospital and cardiac intensive care unit (CICU) stays than White patients but not than “other” patients.Black patients presented with higher severity of illness scores and were more likely than other patients to be admitted to the CICU from inpatient wards rather than the emergency department.Neither hospital/CICU mortality nor use of temporary mechanical circulatory support differed significantly among the groups.Findings suggest that diagnosis of cardiogenic shock in Black patients may be delayed. The authors recommend future studies to examine the effect of disparities in clinical management of cardiogenic shock.See Article, pp 385–389Many professional health care organizations support ventilator liberation to reduce sedative use, ventilator days, and overall length of stay. However, research on staff perceptions of this practice is limited and reported results are conflicting.Rankin and colleagues explored the views of health care staff, including registered nurses, managers, educators, respiratory therapists, and critical care physicians and advanced practice providers (APPs). They found In the future, use of standardized protocols and education of all staff could improve team communication and patient safety.See Article, pp 372–379The mortality rate for patients requiring a resuscitation response is about 70% to 95%. Responding to code blue emergencies can cause psychological distress among staff, possibly leading to burnout and even to leaving the profession. The Pause is a practice whereby clinicians take a moment of silence to honor a patient who has died and let the team process the death.Samai and colleagues examined the impact of implementing the Pause on code blue staff who witnessed death. They found the following: Scores improved after implementation of the Pause, but not significantly. Most staff favored future use of the Pause.See Article, pp 346–353A child’s death in the pediatric intensive care unit (PICU) dramatically affects parents’ lives. In past research, parents who were prepared for their child’s end-of-life (EOL) experience reported less frequent adverse outcomes. Although EOL education is often provided by pediatric clinicians, how they integrate parental anticipatory guidance in EOL care is unclear.Broden Arciprete and colleagues interviewed PICU nurses and found 3 categories of actions used to prepare families for EOL care: These findings can help PICU nurses support families of children nearing the end of life.See Article, pp 380–384