DanGer Shock - First Positive RCT of Impella - Cardiogenic Shock - A critical appraisal
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- Опубликовано: 6 фев 2025
- Vinay Prasad, MD MPH; Physician & Professor
Hematologist/ Oncologist
Professor of Epidemiology, Biostatistics and Medicine
Author of 450+ Peer Reviewed papers, 2 Books, 2 Podcasts, 100+ op-eds.
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Clinical Specialist in industry with Cath Lab Specialist background. Great Video. Been a big Impella “believer” but glad to see you run this video. Thank you.
Dr. Prasad, while I’m completely disgusted with unethical researchers that willingly harm patients in order to achieve a positive endpoint, I absolutely LOVE seeing how passionate and quippy you are when you’re calling out unethical researchers and the absolutely nausea inducing research they shamelessly produce.❤
I agree. I love his delivery.
He is a money-making charlatan - at his worst when vilifying his profession. He disgusts most decent people.
@@Fortune-z1i Got an example?
He certainly "disgusts" the charlatans trying to make money or advance their careers off of desperate sick people by selling them snake oil, doesn't he user-rx5vo3nt4z? ;)
@user-rx5vo3nt4z who you talking about dr. Prasad?
VP- you are going deeper into the statistical nuance these days and there ain’t nuthin wrong with that! It’s up to the listener to try to follow your analysis and hopefully it will begin to make more sense. Keep up your important work!
Dr. Prasad, I would love to see a video on how you teach statistics (Bayesian vs. frequentist). Why the “0.05” can be misleading. Thanks for all your content!
Erm, low-GCS STEMI patients I&V are exactly the group that we'd want to see the intervention for. The baseline survival rate is so low, an improved survival should be very sensitive to detect.
Pump failure is consistently the most difficult form of shock to deal with. Furthermore, you need the patient to be able to survive getting to these procedures in addition to all of the multifactorial of acute heart failure. You said it best yourself, they're selecting all of the "bad" patients out of their patient cohorts and thus biasing the result.
Great points. Thanks for the review. I agree.
Great view on relevance!
I am a retired CCRN. I worked pediatric ICU for 32 years at a level 1 trauma and transplant center.
In the 80's and 90's I ran IAPB on dozens of patients. In those 32 years I have also ran ECMO on hundreds of patients as well as VADs on several others. I don't know about adult post MI or acute cardiomyopathy patients, but I can tell you that the great majority of our ECMO patients made it to discharge even after being on ECMO for weeks in some cases. Again; these are pediatric patients with a wide variety of cardiac insults both congenital and acquired.
Retired PICU RN at a large teaching hospital. We had tons of post-op cardiac patients, lots of ECMO. Not a lot of transplants but the ones we cared for did great. Loved my years in the PICU. The current state of scientific research is very concerning.
I have learned in the last year just how little it feels like the drug studies are about the patients at all! My 16 year old granddaughter was diagnosed with DMG , she had radiation, then was told she didn’t qualify for any trials. Because she didn’t fit perfectly in the narrow qualifications! We were told when she had tumor progression she could be in a slow the tumor trial. Now the hospital nearest to her…which is 3+ hours away isn’t taking patients. She may only have weeks left, and they aren’t taking patients! It really is all about getting their drug to market….not about saving lives!
What’s the over/under on years to medical reversal for this protocol?
And here I am thinking psychologists do shady studies!
Can you comment on Dr Geert Vanden Bossche theory on increasing covid virulence virus is coming ? Is it crap or its plausible ? Sorry for being off topic.
I find it difficult to see the relevance of your arguments. Yes, they did exclude many patients, but what were you expecting? If previous studies yielded negative results by choosing a very broad population, including patients with extremely severe pathologies, then it’s logical to focus on a more selective population with an inherently better prognosis.
In the case of out-of-hospital cardiac arrests, we're dealing with a group of patients with a highly severe prognosis. Their outlook is primarily driven-outside ST+ cases-by neurological rather than cardiovascular status (with a median time in the ecls trial of 20 min before resuscitation). Moreover, post-resuscitation cardiac dysfunction doesn’t operate under the same mechanisms as cardiogenic shock, as there's a significant contribution of vasoplegia related to the systemic inflammatory response after resuscitation, whereas mechanical support works among other things by reducing afterload. They btw didn’t exclude patients who suffered out-of-hospital cardiac arrests if they had a Glasgow score >8.
So how would excluding these cardiac arrest cases be a “huge mistake,” as you put it? Wasn’t the real error in including these patients, for whom the lack of benefit was foreseeable?
This study focuses on a specific category of patients with cardiovascular dysfunction related to acute coronary syndrome, not systemic inflammation. This is a group we encounter frequently in clinical practice. The goal here isn’t to show that Impella or counterpulsation works for all patients in shock, but rather to identify which patient profiles are most likely to respond.
Remember, the MitraFR study found no benefit from the MitraClip, whereas COAPT showed a significant positive effect. The same treatment can vary when baseline prognosis differs due to the severity of the pathology.
I’m so frustrated with the state of medical research. Too much effort is expended creating a study to fit the outcome they desire. Too many patients excluded and too many variables slotted to fit a narrative.
What happened to the VPZD Show?!? Man, those were some great episodes... Keep up the informative push-back against bad medical data!
I don’t know what happened with VPZD show, but when this episode aired I wondered if VP would distance himself. Alas no show since.
ruclips.net/user/liveaO6_-79bMEQ?si=qDdBslaGoR4rwIQL
There was one recent episode, but it was rather not as entertaining as SCV2 days. Ultimately, z is no longer practicing, makes him less relevant.
Let a clever person design the study and you will get whatever result you want.
I keep thinking they know the randomization is reversible, and they merely worsened the outcomes in the control group.
Company-sponsored clinical trials occur for one reason - to make the company money.
This was an independent study
Thoughts on the effect on medicine if the p value for the medical field was raised to the 5-sigma required in physics? Good or bad?
Say goodbye to 90 percent of pharmaceuticals, I'm guessing
@@skaterkraines2691when nearly all of their drug commercials end in cancer and even death... That's pretty darn scary. And look at the definition of synthetic biology from May 22, 2017.
So what are you trying to say about the state of evidence based medicine?
😊
I’m tired of the excuses… I don’t want to be a nurse anymore….😞
First comment! 2 seconds in…not sure where this is going yet.
You have just torn apart the study by finding a difference between the control arm and the intervention populations other than the intervention, itself. Sigh. Even if it started out randomly assigned, the authors can't say their intervention was the cause of the slight but statistically significant effect. This should never have passed an initial peer review.
if you don't agree with this study, then you really ain't a peer!
Very biased take.
You talk too much.
... you waste organs, air, battery charge.
Why tune in if you have that attitude?
@@TheresaGraf
I'm addicted.
@@Andy_T79
True
Very biased take.