The Critical Care Commute Podcast

In this episode, recorded live at CCCF 2024, we sit down with Dr. Emilie Belley-Côté, a cardiac intensivist, researcher, and clinical trialist from McMaster University, to unpack cardiogenic shock: the SCAI classification.Whether you're in the ED, cath lab, or ICU, the SCAI (Society for Cardiovascular Angiography and Interventions) stages offer a common language to describe the severity of cardiogenic shock, guide escalation of care, and improve outcomes through structured assessment.Dr. Belley-Côté walks us through:The five SCAI stages (A through E): what they mean and how they’re used.How this classification system improves communication between specialties.The importance of recognizing patients in pre-shock (Stage B) before they deteriorate.Real-world application: how SCAI staging intersects with clinical signs, biomarkers, and hemodynamic monitoring.Where the SCAI classification fits in research, including trials evaluating mechanical circulatory support and advanced heart failure therapies.With Dr. Belley-Côté’s clear explanations and insights from the front lines of cardiac critical care, this episode is essential listening for anyone managing unstable cardiac patients.

Dr. James Downar, a leading Canadian expert in palliative and critical care, dives into the fascinating world of psychedelics and their potential to alleviate psychological distress in patients facing critical illness. He discusses the transformative powers of substances like psilocybin and MDMA, exploring how they can help individuals confront fear and isolation. The conversation covers the structure of psychedelic-assisted therapy, the importance of 'set and setting,' and the need for compassion in integrating these therapies into traditional care.

Prof. Mervyn Singer, an ICU physician and critical care thought leader, shares insights on ischemia-reperfusion syndrome, a paradox where restoring blood flow can worsen injury. He breaks down the complex mechanisms at play, such as mitochondrial involvement and oxidative stress. The conversation delves into the variability in physiological responses to stress, advocating for a tailored approach to ICU interventions. Prof. Singer emphasizes the importance of clinical judgment and flexibility in treatment protocols, aiming for patient-centered care.

Dr. Mike Christian, a specialist in pre-hospital and critical care medicine with a military background, shares valuable insights on transforming emergency services in Canada. He discusses his unconventional journey from paramedic to physician, highlights the integration of AI in emergency dispatch, and contrasts Canada’s pre-hospital care with global models like the UK's. Mike emphasizes the critical role of physician-led teams, mentorship, and emerging technologies in improving patient outcomes and survival rates during emergencies.

Dr. Elizabeth Viglianti, an assistant professor and critical care specialist at the University of Michigan, shares her expertise on gender-based harassment in the medical field. She recounts her personal experiences that fueled her passion for this vital topic. The conversation delves into the prevalence of harassment and its impact on professional dignity, especially for women. Dr. Viglianti discusses systemic barriers in reporting and highlights recommendations for creating a more equitable and supportive environment in medicine.

We take another break as we are joined by Prof. Wendy Sligl, formidable ID and ICU doc, to discuss the critical topic of optimizing antibiotic prescribing in critical care settings. The discussion covers various aspects of antibiotic use, including the importance of timely administration, the role of communication in ensuring effective treatment, and the nuances of dosing strategies such as loading doses and continuous infusions. The conversation also delves into the duration of antibiotic therapy, emphasizing the need for individualized treatment based on patient response. Takeaways:Infections are common in intensive care units, and sepsis is a life-threatening condition.Identifying the clinical syndrome is crucial for appropriate antibiotic therapy.Empiric therapy is often necessary before culture data is available.Timely administration of antibiotics is linked to better patient outcomes.Communication among healthcare teams is essential for effective antibiotic delivery.Loading doses can help achieve therapeutic levels quickly in critically ill patients.Continuous infusions of certain antibiotics may improve clinical outcomes.Shorter courses of antibiotics can be as effective as longer ones.Monitoring patient response is key to adjusting antibiotic therapy.Consulting infectious disease specialists can enhance treatment strategies.Chapters:00:00Introduction to Antibiotic Optimization01:07Understanding Infections and Sepsis02:47Emergency Room Protocols for Antibiotic Administration04:56Identifying Sepsis and Administering Antibiotics06:33Communication and Timeliness in Antibiotic Delivery08:42Optimizing Antibiotic Dosing Strategies10:59Pharmacodynamics and Continuous Infusions12:44Duration of Antibiotic Therapy18:52Monitoring and Adjusting Antibiotic Treatment21:39The Debate on Antibiotic Duration26:37Specific Infections and Treatment Duration31:24Practical Strategies for Antibiotic Stewardship32:43Rapid Fire Questions on Antibiotic Use

Dr. Darryl Abrams, Associate Medical Director of the Medical ECMO Program at New York-Presbyterian/Columbia University, dives into the transformative world of extracorporeal cardiopulmonary resuscitation (eCPR). He breaks down key trials like ARREST and Prague OHCA, highlighting their impact on clinical practice. The discussion covers challenges in implementing eCPR, including patient selection and ethical considerations regarding access to this advanced care. Abrams also contrasts healthcare models in the U.S. and Canada, shedding light on disparities in treatment.

Dr. Sean van Diepen, an Associate Professor and Co-Director at the Mazankowski Alberta Heart Institute, shares his expertise on extracorporeal life support in cardiogenic shock. He discusses the evolution of mechanical circulatory support, highlighting findings from the DANGER trial showing a 20% mortality reduction with the Impella device. The ECLS-SHOCK trial raises concerns about complications despite lack of mortality benefit. Van Diepen emphasizes the need for better patient selection and collaborative care in this critical area of cardiac medicine.

In this captivating conversation, Major General Tim Hodgetts, the recently retired top medical advisor for UK forces, shares his transformative journey in emergency medicine. He discusses revolutionary advancements in combat casualty care, influenced by his early traumatic experiences. Hodgetts highlights the importance of international collaboration and cultural dynamics in multinational medical teams. He also delves into coping mechanisms for trauma, emphasizing peer support, and reflects on his ongoing commitment to education and community service in both military and civilian healthcare.

Dr. Rebecca Mathew, a cardiologist and critical care specialist at the University of Ottawa Heart Institute, shares insights on refractory cardiac arrest practices. She discusses advanced techniques like double sequential defibrillation and the use of antiarrhythmics like amiodarone and lidocaine. The episode highlights the role of ECPR and the challenges of patient selection. Additionally, Dr. Mathew emphasizes the importance of patient engagement in critical care and the need for a cultural shift in clinical trial participation to improve treatment outcomes.