Dr. Shannon Fernando is an intensivist at Lakeridge Health and a prolific researcher with over 150 publications. Known for his work in outcomes-based research across critical care, he joins us to discuss long-term outcomes after cardiogenic shock.

About the Episode:

This episode is part of our cardiovascular critical care series and explores what happens after the ICU for patients who survive cardiogenic shock. We unpack quality of life, functional outcomes, mental health, and the hidden burdens on both patients and caregivers. Dr. Fernando provides key data insights from his large cohort studies and shares reflections from ICU follow-up clinics. We also dive into the challenges of prognostication and how to communicate realistic expectations to families.

Topics Covered

Defining Long-Term Outcomes:

Beyond survival: functional independence, mental health, cognition, and system resource use.

Key Findings from Ontario Cohort

42% of cardiogenic shock survivors require increased levels of care

15% die within a year post-discharge

Modest impact of revascularization or mechanical support on long-term outcomes

Morbidity and Quality of Life

Loss of independence and inability to return to work

High incidence of PTSD, depression, and caregiver burden

Delayed functional recovery and unmet expectations

Prognostic Factors and Predictive Markers

Frailty as a key indicator

Pre-existing mental health as a predictor of post-ICU mental health outcomes

In-hospital arrest characteristics: rhythm, downtime, comorbidities

ICU Follow-Up Clinics

Value in knowledge translation and emotional support

Real-world insights on functional recovery and patient satisfaction

Common patient sentiment: gratitude mixed with trauma

Communication with Families

Avoiding value imposition

Emphasizing trajectory over fixed timelines

Balancing hope with realism

Rethinking Endpoints in Research

Limitations of 28-day mortality

Need for patient-centered, long-term functional outcomes

Trajectory-based data over snapshot metrics

Knowledge Translation as the Intervention

Equipping clinicians and patients with realistic expectations

Normalizing psychological responses

Shaping future research directions around lived experience

Long Term Outcomes after ICU, CPR, and Cardiogenic Shock