Treatment for refractory hypotension

If hypotension is refractory, seek advice from a clinical toxicologist regarding the use of additional inotropes. Bedside echocardiography can help to assess ventricular function and guide therapy.

In the context of refractory cardiogenic shock, use cardiac assist devices and extracorporeal circulatory support if available. Temporary cardiac pacing is sometimes required.

Inotropes are less effective in the setting of acidosis. In patients with refractory hypotension who have severe metabolic acidosis, seek expert advice on correcting acidosis.