Cardiogenic Shock in Pregnancy: A Practical CICU Approach with Dr. Ricky Hansra

Managing cardiogenic shock is challenging in any patient. Add pregnancy to the equation, and even experienced cardiac intensivists must navigate a unique set of physiologic, clinical, and ethical challenges. In this episode of SoCCC Pre-Rounds, host Dr. Elliott Miller sits down with Dr. Ricky Hansra, co-director of the Cardiac Intensive Care Unit at Vanderbilt and an expert in cardio-obstetrics, for a practical discussion on caring for pregnant patients with cardiogenic shock. Together, they explore the foundational principles of managing these critically ill patients, including how pregnancy alters cardiovascular physiology, how to interpret hemodynamics in this unique population, and why supporting maternal circulation is central to supporting fetal well-being. Dr. Hansra discusses the role of pulmonary artery catheterization, bedside hemodynamic monitoring, vasopressor and inotrope selection, and the use of mechanical circulatory support including ECMO. He shares practical CICU pearls on anticoagulation strategies, delivery planning, and managing the challenges created by a growing uterus during mechanical support. The conversation also covers the care of patients with pre-existing cardiomyopathy during pregnancy, including optimization strategies, multidisciplinary planning, and coordination between cardiology, maternal-fetal medicine, obstetrics, anesthesia, cardiac surgery, and critical care teams. Designed for residents, fellows, intensivists, cardiologists, and CICU teams, this episode provides a practical framework for approaching one of the most complex scenarios in critical care cardiology: the pregnant patient in cardiogenic shock. Key topics covered: Initial approach to cardiogenic shock during pregnancy Understanding normal pregnancy physiology and abnormal hemodynamics Pulmonary artery catheter use in the CICU Vasopressor and inotrope selection ECMO and mechanical circulatory support considerations Anticoagulation and delivery planning Managing cardiomyopathy during pregnancy The importance of multidisciplinary cardio-obstetric care Dr. Ricky Hansra https://medicine.vumc.org/department-directory/Barinder-Hansra https://x.com/RickyHansra Dr. Elliot Miller https://x.com/ElliottMillerMD https://www.soccc.org/ Supported By: This episode is made possible by unrestricted support from Zoll LifeVest — thanks for keeping high-impact education free for our community. Disclaimer This podcast is not medical advice, just candid, practical discussions about what your hosts do every day in the CICU. Always consult your supervising team and current guidelines before applying any interventions.