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The Critical Care Commute Podcast
Critical Care Commute
86 episodes
1 week ago
The Critical Care Commute Podcast is grateful for your ears, insights and feedback. In return its hosts- Peter Brindley and Leon Byker, two ICU doctors in Alberta, Canada- offer up knowledge and debate with some of the most qualified, interesting, enlightened and provocative folks in Critical Care Medicine, and beyond. We strive to keep it practical and concise. Like you, our overriding goal is to get better, do better and feel better.
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Medicine
Health & Fitness
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All content for The Critical Care Commute Podcast is the property of Critical Care Commute and is served directly from their servers with no modification, redirects, or rehosting. The podcast is not affiliated with or endorsed by Podjoint in any way.
The Critical Care Commute Podcast is grateful for your ears, insights and feedback. In return its hosts- Peter Brindley and Leon Byker, two ICU doctors in Alberta, Canada- offer up knowledge and debate with some of the most qualified, interesting, enlightened and provocative folks in Critical Care Medicine, and beyond. We strive to keep it practical and concise. Like you, our overriding goal is to get better, do better and feel better.
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Medicine
Health & Fitness
Episodes (20/86)
The Critical Care Commute Podcast
Precision Medicine - It may be easier than you think!

In this episode, Peter and Leon, recording at the College of Intensive Care Medicine's Conference in Tasmania, Australia, discuss advancements in precision medicine with Dr. Pratik Sinha from Washington University in St. Louis.


Dr Pratik trained in both Emergency and Intensive Care Medicine, but only works clinically as an intensivist. He runs a research program that seeks to change the way we identify and classify critically ill patients, by using a combination of novel biological measurements and state of the art data science approaches.

The conversation delves into how critical care medicine currently operates, emphasizing the need to shift from supportive care to more personalized approaches using biological measuring systems, big data, and novel data science techniques. They discuss identifying patient subgroups using machine learning algorithms and protein biomarkers, revealing phenotypes like hyper and hypo-inflammatory responses. The discussion covers the practical challenges of implementing these technologies, the importance of rigorous testing, and the future implications for intensive care. The speakers highlight the necessity of prospective clinical trials and broader accessibility of these advanced diagnostic tools to improve patient outcomes.

00:00 Introduction and Opening Remarks

00:34 Diving into Precision Medicine

01:35 Elevator Pitch for Medical Research

02:10 Understanding Patient Complexity

04:12 Biological Measurements and Data Science

10:37 Challenges in Modern Medicine

17:08 Future of Medical Research and AI

21:20 Concluding Thoughts and Future Prospects

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3 weeks ago
31 minutes 2 seconds

The Critical Care Commute Podcast
Mystery Guest - Dr Smith and the future of Critical Care Medicine.

In this episode of the Critical Care Commute podcast, Dr. Smith discusses the multifaceted future of critical care medicine, touching on economic, political, and technological challenges.

The conversation delves into the role of artificial intelligence in enhancing healthcare, the importance of clinician well-being, and the need for a human touch in medicine.

The discussion also explores personal interests, travel experiences, and the ethical implications of AI in clinical practice, emphasizing the balance between technology and human interaction.


Guests: Drs Marcus Peck and Jonny Wilkinson.


Chapters

00:00 The Future of Critical Care Medicine

02:40 Artificial Intelligence in Healthcare

05:38 Human Factors and Clinician Well-being

08:22 Economic Challenges in Healthcare

11:09 The Role of Politics in Healthcare

14:13 The Turing Test and AI's Evolution

16:41 Personal Interests and Travel Experiences

19:57 AI's Impact on Clinical Practice

22:38 Ethical Considerations of AI in Medicine

25:19 The Future of AI and Human Interaction


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1 month ago
43 minutes 40 seconds

The Critical Care Commute Podcast
The Power of Kindness

The Power of Kindness in Healthcare: A Conversation with Dr. Suzanne Crowe. In this episode, Peter Brindley and Leon Byker speaks with Dr. Suzanne Crowe, pediatric intensivist and president of the Medical College of Ireland, at the College of Intensive Care meeting in Tasmania, 2025.

They explore the significant impact of kindness on patient outcomes, emphasizing its vital role in healthcare. Dr. Crow highlights the necessity of incorporating kindness as a core practice, noting that it reduces mistakes, improves diagnostic accuracy, and fosters better cooperation from patients. They discuss the effectiveness of empathy training and the importance of leadership in fostering a culture of kindness within healthcare systems. Dr. Crow also shares practical tips for healthcare professionals on how to demonstrate kindness in daily interactions, such as sitting beside patients and offering comforting gestures.00:00 Introduction and Guest Welcome00:34 The Power of Kindness in Healthcare01:24 Defining and Recognizing Kindness02:20 Microdosing Kindness in Practice03:19 Teaching and Modeling Kindness03:54 Empathy Training and Its Importance05:07 Challenges and Barriers to Kindness06:57 Kindness in Patient Interactions09:27 Systemic Kindness and Leadership17:17 Empathy Training Techniques19:00 Conclusion and Final Thoughts

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1 month ago
20 minutes 40 seconds

The Critical Care Commute Podcast
Remote River Rescue: A Story of Triumph in Tasmania

Join Peter Brindley and Leon Byker as they host David Bertoni, an ED physician and ECMO clinical lead, and Jorian 'Joe' Kippax, a trauma specialist and reservist, for an incredible story of a remote river rescue in Tasmania.

The team responds to a distress call from a trapped rafting party in the Franklin River, one of Tasmania's most remote and formidable areas. The rescue involves complex logistical challenges, a field amputation, and the use of ECMO technology amidst perilous conditions. The patient, after 20 hours trapped in frigid water, undergoes a harrowing yet successful rescue and recovery. This episode offers a gripping recount of teamwork, medical ingenuity, and human resilience.00:00 Introduction and Guest Overview00:40 Setting the Scene: Remote River Rescue01:39 The Rescue Operation Begins03:13 Challenges and Techniques in the Rescue07:25 Field Amputation and Extraction18:35 Transport and ECMO Preparation23:20 Hospital Arrival and ECMO Procedure26:18 Patient Recovery and Reflections30:45 Conclusion and Final Thoughts

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2 months ago
32 minutes 21 seconds

The Critical Care Commute Podcast
Sepsis Updated: Prof Mervyn Singer, Author of Sepsis 3.0

In this episode, we welcome Professor Mervyn Singer, author of Sepsis 3.0. Sepsis remains one of the most complex and deadly conditions in critical care. In this conversation,Professor Singer shares his perspectives on the shifting landscape of sepsis treatment, the role of antibiotics, steroids, metabolic interventions, and the future ofprecision medicine.

He also challenges some long-standing dogmas and emphasizes the importance of individualized care over rigid guidelines.

Key Topics and Chapters:

The Evolution of Sepsis Management

  • Historical perspectives on sepsis treatment
  • Earlier recognition and intervention leading to improved outcomes

Current Challenges and Research Directions

  • Organ dysfunction and recovery in sepsis
  • The importance of metabolic manipulation and mitochondrial function

The Role of the Immune System in Sepsis

  • Understanding hyper- and hypo-inflammatory responses
  • Steroid use in critical illness—when it works and when it doesn’t

Antibiotics in Sepsis: How Soon, How Long, and How Much?

  • The changing approach to antibiotic timing and duration
  • The impact of microbiome disruption and antibiotic toxicity
  • Rethinking the one-hour antibiotic rule

Lessons from COVID-19 and Their Impact on Sepsis Research

  • The importance of phenotype-driven treatments
  • Missed opportunities in clinical trials and biobanking

The Beta-Blocker Debate in Sepsis

  • Potential benefits in selected patients
  • The challenge of distinguishing compensatory tachycardia from harmful sympathetic overdrive

Rethinking Fever Management

  • Is fever protective or harmful?
  • When to treat and when to leave it alone

Guidelines vs. Individualized Care

  • The balance between evidence-based medicine and clinical expertise
  • The dangers of rigid mandates and protocols


This engaging discussion provides a fresh perspective on the current state and future of sepsis management, emphasizing the need for precision medicine, nuanced clinical decision-making, and ongoing research.

References:

  1. Im Y, Kang D, Ko RE, et al. Time-to-antibiotics and clinical outcomes in patients with sepsis and septic shock: a prospective nationwide multicenter cohort study. Crit Care. 2022;26(1):19. Published 2022 Jan 13. doi:10.1186/s13054-021-03883-0 Here
  2. Sakkat A, Alquraini M, Aljazeeri J, Farooqi MAM, Alshamsi F, Alhazzani W. Temperature control in critically ill patients with fever: A meta-analysis of randomized controlled trials. J Crit Care. 2021;61:89-95. doi:10.1016/j.jcrc.2020.10.016 Here
  3. Hasegawa D, Sato R, Prasitlumkum N, et al. Effect of Ultrashort-Acting β-Blockers on Mortality in Patients With Sepsis With Persistent Tachycardia Despite Initial Resuscitation: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Chest. 2021;159(6):2289-2300. doi:10.1016/j.chest.2021.01.009 Here
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2 months ago
26 minutes 32 seconds

The Critical Care Commute Podcast
Long Term Outcomes after ICU, CPR, and Cardiogenic Shock

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


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3 months ago
24 minutes 32 seconds

The Critical Care Commute Podcast
Cardiogenic Shock: The SCAI Classification with Dr. Emilie Belley-Côté.

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.

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4 months ago
19 minutes 57 seconds

The Critical Care Commute Podcast
Psychedelics: Is it time to change your mind? With Dr James Downer.

In this episode, we’re joined by Dr. James Downar, a leading Canadian voice in palliative and critical care, for a wide-ranging discussion on the emerging role of psychedelics in managing psychological and existential distress.

Psychedelics have gone from fringe to forefront in recent years, and we dig into what that shift might mean for patients facing critical illness or the end of life.

What psychedelics are and how they work

  • Substances like psilocybin, LSD, ketamine, and MDMA

  • Key effects: altered perception, ego dissolution, and emotional insight

  • Risks and benefits in vulnerable populations

Psychedelic-assisted therapy: structure and process

  • The three-phase model: preparation, the session itself, and integration

  • Micro dosing vs. full therapeutic sessions

  • Where current evidence stands

Potential applications in critical care and palliative medicine

  • Helping patients process fear, isolation, and suffering

  • How psychedelics differ from traditional symptom management tools like opioids

  • Limitations in advanced illness due to physiological concerns

Research and implementation challenges

  • Problems with study design and placebo controls

  • The importance of ‘set and setting’

  • Defining success in existential or spiritual distress

Ethical considerations and clinical integration

  • Balancing innovation with compassion and caution

  • Avoiding reductionism: why psychedelics should complement—not replace—human care

  • The future role of these therapies in ICU and palliative settings

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4 months ago
17 minutes 16 seconds

The Critical Care Commute Podcast
Ischemia Reperfusion Syndrome with Prof. Mervyn Singer

Recorded live at the Canadian Critical Care Forum 2024 in Toronto, this episode dives into the complex world of ischemia-reperfusion syndrome — the paradox where restoring blood flow causes further injury. We explore the underlying mechanisms, clinical implications, and future directions in managing this phenomenon.

Joining us for the third time is Prof. Mervyn Singer, ICU physician, researcher, and thought leader in critical care physiology. Known for challenging dogma and making complex science accessible, Prof. Singer unpacks this important topic with clarity and insight.

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5 months ago
21 minutes 4 seconds

The Critical Care Commute Podcast
If It Goes by Air, Should a Doctor Not Be There? Pre-Hospital Care with Dr. Mike Christian

Dr. Mike Christian is a critical care and pre-hospital medicine specialist with extensive experience in aeromedical transport and military medicine. His diverse career spans work as a paramedic, internal medicine and critical care training, and roles as a flight physician with London Air Ambulance and the Canadian military. He is a leading advocate for integrating interprofessional teams and advancing physician-led pre-hospital care in Canada. Currently, he is involved in the MedResponse BC initiative, which aims to enhance critical care delivery outside of hospitals.

In this episode, Peter and Leon sit down with Mike to explore the evolving landscape of pre-hospital critical care. From his unconventional career path to the integration of AI in emergency response, he shares insights on improving outcomes in pre-hospital medicine and the lessons Canada can learn from global high-performance systems.


Key Topics & Chapters

Mike’s Career Journey

  • From paramedic to physician: an unconventional path
  • Military and aviation medicine experience
  • The shift to leadership in pre-hospital care

Pre-Hospital Critical Care: Canada vs. The World

  • How Canada’s HEMS (Helicopter Emergency Medical Services) differs from global models
  • Lessons from the UK, Australia, and Denmark
  • The role of AI in dispatch and triage

The Role of Physicians in Pre-Hospital Medicine

  • The evolving need for physician-led care outside the hospital
  • The impact of interprofessional teams on survival rates
  • Mentorship, coaching, and cultural change in pre-hospital systems

The Role of the Physician in Pre Hospital Medicine.

  • AI-powered dispatch and GoodSAM app in improving CPR and trauma response
  • Scoop and run vs. stay and play: What actually saves lives?
  • Addressing Canada’s geographical challenges with rural and remote care

Future Directions in Pre-Hospital Medicine

  • The rise of telemedicine and virtual ICUs
  • Developing triage physicians and training programs
  • MedResponse BC: A new model for interprofessional pre-hospital care


Keywords:

Pre-hospital care, critical care transport, HEMS, trauma response, paramedics, physician-led pre-hospital medicine, telemedicine, AI in emergency medicine, interprofessional teams, rural emergency care, GoodSAM app, London Air Ambulance, MedResponse BC.


Links of Interest:

  1. CCCF Presentation:  https://youtu.be/MVDHaYaZRSI  (Web view)
  2. Recent Publication:  https://doi.org/10.1186/s13049  (Web view)



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6 months ago
30 minutes 5 seconds

The Critical Care Commute Podcast
Gender-Based Harassment in the Medical Workplace: Insights from Dr. Elizabeth Viglianti

In this episode, hosts Leon Byker and Peter Brindley are joined by Dr. Elizabeth Viglianti, an assistant professor at the University of Michigan, Pulmonologist and Critical Care Specialist, to discuss the crucial issue of gender based harassment in medicine.


Gender-Based Harassment refers to any unwelcome behavior, comment, or conduct that demeans, intimidates, or disadvantages someone based on their gender or gender identity. This can include derogatory remarks, exclusion, stereotyping, unequal treatment, or threats, whether or not the behavior is sexual in nature. In the workplace, it undermines professional dignity and contributes to a hostile or inequitable environment.


Dr. Viglianti shares her personal experience that led her to study this field, detailing the prevalence and impact of such harassment. The discussion covers key findings from the National Academies of Science, Engineering, and Medicine's framework on addressing sexual and gender based harassment, gender disparities, organizational factors contributing to harassment, and her research on the topic. Practical steps and recommendations for institutions to mitigate harassment are also explored.



00:00 Introduction and Welcome

01:08 Personal Experience with Sexual Harassment

03:06 Understanding Gender Based Harassment in Medicine

05:34 Organizational Factors and Solutions

07:50 Gender Disparities in Academic Medicine

17:42 Impact on Trainees and Reporting Challenges

24:46 Addressing Patient-Perpetrated Harassment

28:59 Practical Strategies and Training

32:26 Conclusion and Call to Action


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6 months ago
32 minutes 43 seconds

The Critical Care Commute Podcast
Optimizing Antibiotics with Prof. Wendy Sligl.

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:

00:00

Introduction to Antibiotic Optimization

01:07

Understanding Infections and Sepsis

02:47

Emergency Room Protocols for Antibiotic Administration

04:56

Identifying Sepsis and Administering Antibiotics

06:33

Communication and Timeliness in Antibiotic Delivery

08:42

Optimizing Antibiotic Dosing Strategies

10:59

Pharmacodynamics and Continuous Infusions

12:44

Duration of Antibiotic Therapy

18:52

Monitoring and Adjusting Antibiotic Treatment

21:39

The Debate on Antibiotic Duration

26:37

Specific Infections and Treatment Duration

31:24

Practical Strategies for Antibiotic Stewardship

32:43

Rapid Fire Questions on Antibiotic Use

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7 months ago
30 minutes 7 seconds

The Critical Care Commute Podcast
The Present and Future of eCPR with Dr Darryl Abrams

Following the discussion on ECLS in AMI and cardiogenic shock, we go on to discuss eCPR for cardiac arrest specifically. This episode was recorded live at the Critical Care Canada Forum 2024 as part of our special series on cardiac intensive care.

Our guest is Dr. Darryl Abrams, Associate Medical Director and Director of Research for the Medical ECMO Program at New York-Presbyterian/Columbia University. Dr. Abrams joins us for an in-depth discussion on the current state and future direction of extracorporeal cardiopulmonary resuscitation, or eCPR.

We dive into the complex world of eCPR in refractory cardiac arrest, starting with a breakdown of the three landmark trials that have shaped the field: the ARREST trial, the Prague OHCA trial, and the INCEPTION trial. Each study offers a unique perspective, from the dramatic early findings of ARREST to the pragmatic design of Prague OHCA and the sobering multicenter outcomes of INCEPTION.

A major theme throughout the episode is the role of system design. Dr. Abrams emphasizes the importance of minimizing low-flow time, rapid cannulation, and consistent team expertise—factors that can make or break the success of eCPR.

We also explore the ethical and practical considerations that come with rolling out such a resource-intensive intervention, including the balance between innovation and equity. Is it fair that access to eCPR may depend on geography or institutional resources? And how do we make meaningful improvements in survival when only a few centers can offer this advanced care?

The episode closes with a practical lens: how should clinicians approach building an ECMO program? What are the essential pieces that need to be in place before considering eCPR? And how do you select patients in a way that balances risk, benefit, and system capacity?

Chapters:

  • Introduction and guest welcome

  • Setting the scene: What is eCPR and why now?

  • The ARREST trial: Small study, big impact

  • The Prague OHCA trial: Early randomization, broader population

  • The INCEPTION trial: Multicenter reality and negative results

  • Comparing the evidence: Why do outcomes differ?

  • Low-flow time and speed of cannulation

  • The role of meta-analyses and what they do (and don’t) tell us

  • Opportunity cost: What are we giving up to fund eCPR?

  • Duration of support: How long is too long?

  • Will there be another trial? Challenges of equipoise

  • Building a responsible eCPR program

  • Patient selection: Who qualifies and why?

  • Cannulation techniques and adjunct devices

  • System design: U.S. vs. Canada vs. U.K.

  • Ethical concerns and access inequities

  • Guidelines and final takeaways

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8 months ago
29 minutes 14 seconds

The Critical Care Commute Podcast
Extracorporeal Support in Cardiogenic Shock - A Look at the Evidence with Dr Sean van Diepen

In this episode, recorded live at the Critical Care Canada Forum in Toronto, we dive into extracorporeal life support (ECLS) in cardiogenic shock, with Dr Sean van Diepen.

He is an Associate Professor at the University of Alberta, Co-Director of the CCU at the Mazankowski Alberta Heart Institute, and a leading voice in cardiac critical care.

Join us as we explore the evolving landscape of mechanical circulatory support, the latest evidence from the DANGER and ECLS-SHOCK trials, and the complexities of patient selection.

Key Topics Covered:

1. The Evolution of ECLS in Cardiogenic Shock

• The 25-year gap since the last positive cardiogenic shock trial.

• How mechanical circulatory support expanded despite limited evidence.

2. The DANGER Trial – Impella in AMI-Associated Cardiogenic Shock

• Mechanism and function of the Impella device.

• Trial results: 20% mortality reduction at 180 days.

• Complications: Limb ischemia, hemolysis, and high costs.

• Real-world application: Who actually qualifies?

3. ECLS-SHOCK Trial – ECMO for Cardiogenic Shock

• A "negative" trial, but a crucial wake-up call.

• No mortality benefit but significantly higher complication rates.

• Controversies: Inclusion of cardiac arrest patients and transition to destination therapy.

• Future directions: Can patient selection improve outcomes?

4. ECPR – Extracorporeal Support in Refractory Cardiac Arrest

• Review of the ARREST, PRAGUE, and INCEPTION trials.

• Why the evidence remains unclear and institution-dependent.

• The role of high-volume ECMO centers and standardized pathways.

5. The Future of ECLS – Cost, Ethics, and Decision-Making

• How should institutions decide who gets ECMO?

• The role of cardiogenic shock teams.

• Could AI play a role in decision-making?

• The challenge of resource allocation in a single-payer system.

Key Takeaways:

✅ Impella shows promise in carefully selected AMI shock patients but is costly and high-risk.

✅ ECMO for cardiogenic shock remains controversial—patient selection is key.

✅ ECPR is promising but needs further trials and structured implementation.

✅ Cardiogenic shock management should be a team decision, not an individual one.

🔊 Listen now and join the conversation on the future of cardiac critical care!


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8 months ago
22 minutes 37 seconds

The Critical Care Commute Podcast
Combat Medicine: Universal Lessons for the Battlefield and Civilian Streets with Major General Tim Hodgetts CB CBE KHS DL

We’re taking a break from our Cardiac Critical Care series to bring you a conversation with one of the most influential figures in medicine.

Peter had the huge privilege of interviewing Major General Tim Hodgetts, the recently retired, most senior medical advisor in the UK forces.

Hodgetts shares his remarkable journey in transforming emergency medicine from its infancy to maturity, detailing poignant experiences from his early career that steered him towards this specialty. The discussion ranges from Hodgetts' pioneering efforts in combat casualty care, the evolution of battlefield first aid, and innovative medical practices in conflict zones, to his concepts on leadership, international collaborations, and coping with trauma.

The segment also touches on Hodgetts' recent retirement and his ongoing contributions to medical and military communities through teaching, charity work, and writing.


Chapters:

00:00 Introduction and Guest Overview

02:56 Early Career and Influences

06:25 Pioneering Emergency Medicine in the Military

08:13 Revolutionizing Combat Casualty Care

17:55 International Collaboration and Cultural Insights

30:31 Leadership in Crisis

35:35 Coping with Trauma and Personal Reflections

39:43 Retirement and Legacy

42:29 Conclusion and Final Thoughts


This has been one of my absolute favorite podcasts to produce! What an honor to have Major General Tim Hodgetts join us on the Critical Care Commute!

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9 months ago
44 minutes 6 seconds

The Critical Care Commute Podcast
Refractory Cardiac Arrest - A Clinical Practice Update with Dr Rebecca Mathew

Recorded live at the Critical Care Canada Forum 2024, this episode is part of our special Cardiac ICU Series.

Dr. Rebecca Mathew, cardiologist and critical care specialist at the University of Ottawa Heart Institute, joins us to discuss the latest refractory cardiac arrest practice updates, including antiarrhythmic drugs, defibrillation strategies, and the role of ECPR.


Chapters:

• Defining refractory cardiac arrest

• Antiarrhythmic drugs: amiodarone vs. lidocaine

• Defibrillation strategies: vector change and double sequential defibrillation

• Emerging therapies: stellate ganglion blocks and electrical storm management

• ECPR: who qualifies and what the trials say

• Equity and feasibility challenges in cardiac arrest management

• ICU recovery clinics and patient-centered outcomes

• Clinical trials: barriers to enrollment and the need for change


References:

1. ROC ALPS Trial: 1. Kudenchuk PJ, Brown SP, Daya M, et al. Resuscitation Outcomes Consortium-Amiodarone, Lidocaine or Placebo Study (ROC-ALPS): Rationale and Methodology Behind an Out-of-Hospital Cardiac Arrest Antiarrhythmic Drug Trial. American Heart Journal. 2014;167(5):653-9.e4. doi:10.1016/j.ahj.2014.02.010. PMID: 24766974.[1]

2. DOSE VF: Cheskes S, Drennan IR, Turner L, Pandit SV, Dorian P. The Impact of Alternate Defibrillation Strategies on Shock-Refractory and Recurrent Ventricular Fibrillation: A Secondary Analysis of the DOSE VF Cluster Randomized Controlled Trial. Resuscitation. 2024;198:110186. doi:10.1016/j.resuscitation.2024.110186. PMID: 38522736

3. ARREST: Yannopoulos D, Bartos J, Raveendran G, et al. Advanced Reperfusion Strategies for Patients With Out-of-Hospital Cardiac Arrest and Refractory Ventricular Fibrillation (ARREST): A Phase 2, Single Centre, Open-Label, Randomised Controlled Trial. Lancet (London, England). 2020;396(10265):1807-1816. doi:10.1016/S0140-6736(20)32338-2. PMID: 33197396

4. INCEPTION: Ubben JFH, Suverein MM, Delnoij TSR, et al. Early Extracorporeal CPR for Refractory Out-of-Hospital Cardiac Arrest - A Pre-Planned Per-Protocol Analysis of the INCEPTION-trial. Resuscitation. 2024;194:110033. doi:10.1016/j.resuscitation.2023.110033. PMID: 37923112

Disclaimer:

This episode is for educational purposes only and does not constitute medical advice. The views expressed are those of the hosts and guests and do not necessarily reflect their employers.


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9 months ago
25 minutes 17 seconds

The Critical Care Commute Podcast
Clinical Practice Update on Optimal Post Cardiac Arrest and Refractory Cardiac Arrest Patient Care with Dr Janek Senaratne.

Welcome to our first episode in a series on Cardiac Intensive Care, recorded live at the Critical Care Canada Forum 2024. We kick off by looking at the latest Clinical Practice Update on post cardiac arrest care and refractory cardiac arrest.

The "Canadian Cardiovascular Society/Canadian Cardiovascular Critical Care Society/Canadian Association of Interventional Cardiology Clinical Practice Update on Optimal Post Cardiac Arrest and Refractory Cardiac Arrest Patient Care" CCS was published in 2024, and provides comprehensive recommendations for the management of patients following cardiac arrest.

Join us as Dr Janek Senaratne unpacks this Clinical Practice Update (CPU), and guides us through the evidence for the recommendations made.

Dr. Janek Senaratne is a dual-trained cardiologist and intensivist based in Edmonton, Alberta. He serves as an Associate Clinical Professor in the Department of Medicine at the University of Alberta. University of Alberta In his clinical roles, Dr. Senaratne practices at the University of Alberta Hospital and Grey Nuns Hospital, and is one of the Vital Heart Response physicians for the province.


Further Reading:

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10 months ago
29 minutes 38 seconds

The Critical Care Commute Podcast
How We Think, How We Communicate - Where are we Going?

Recorded live at the Toronto Critical Care Canada Forum, this episode features a conversation with Prof. Derek Angus, Professor at the University of Pittsburgh, senior editor at JAMA, and Vice Chair of Innovation.

We discuss the evolution of healthcare systems, the art of decision-making, the role of AI, and how to inspire the next generation of clinicians.


Chapters:

Welcome to the Forum

  • Introductions and reflections on the energy of in-person conferences post-COVID.
  • Setting the stage with Dr. Angus and his storied career.

Conferences: More Than Just Science

  • The dual role of conferences as spaces for rigorous science and informal discussion.
  • How smaller, focused meetings like CCR foster deeper conversations.
  • How We Communicate Science

Reflections on the digital age: Do we risk dumbing things down too much?

  • The balance between simplicity and nuance in medical publishing.

The AI Frontier in Medicine

  • Separating hype from reality: Why AI isn’t replacing doctors just yet.
  • The cognitive load of decision-making and where technology fits in.

Thinking, Fast and Slow

  • Exploring System One and System Two decision-making.
  • The growing interest in how groups make decisions in critical care settings.

Redefining Careers in Medicine

  • Moving beyond traditional roles to focus on leadership, innovation, and teamwork.
  • Advice for the next generation on thinking outside the box.

Building Better Healthcare Systems

  • Shifting accountability from individual outcomes to system-wide improvement.
  • Transparency and trust: Why they’re essential for the future of healthcare.

Closing Thoughts

  • Dr. Angus reflects on his legacy and hopes for the next wave of clinicians.
  • A heartfelt thanks and a promise for more conversations ahead.


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10 months ago
24 minutes 7 seconds

The Critical Care Commute Podcast
Code Green or Code Greed? Dr John Kellum

Health Economics 101: "Code Green - How the big lie in health care affects us all."

Prof. John Kellum, is a Professor of Critical Care Nephrology and now provocative author! Join us as he talks to us about his book: "Code Green - How the Big Lie in Healthcare Affects Us All."

Conflict Declaration:

The hosts and producers of this podcast declare no financial gain or conflict of interest from this episode or the promotion of Code Green. Our only goal is to share the insights and expertise of Dr. Kellum with our audience.

Episode Chapters:

  1. Welcome and Introduction
  2. Why Code Green? The inspiration behind the book.
  3. The Evolution of U.S. Healthcare: From the 1980s to today.
  4. The "Big Lie" in Healthcare: How hospitals maintain profits while claiming financial distress.
  5. Trust and Its Erosion in Medicine: Exploring the misalignment between physicians, hospitals, and patient care.
  6. Burnout or Moral Injury? Understanding the psychological toll of compromised care.
  7. Aligning Values with Care: Dr. Kellum’s actionable solutions for a better healthcare system.
  8. The Role of Patients in Reform: How patients can become advocates for systemic change.
  9. Closing Thoughts and Takeaways: Dr. Kellum’s message to healthcare professionals and patients alike.


Further Resources:

• Code Green: How the Big Lie in Healthcare Affects Us All


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11 months ago
33 minutes 3 seconds

The Critical Care Commute Podcast
Hyperbaric Medicine: A Deep Dive with Dr Jeff Kerrie

In this episode, we dive into the fascinating world of Hyperbaric medicine with Dr. Jeff Kerrie, a Hyperbaric specialist from British Columbia, Canada.

Dr. Kerrie takes us through the science, history, and practical applications of Hyperbaric oxygen therapy (HBOT) as we explore the approved indications, physiological effects, and logistics of managing hyperbaric chambers.


Episode Chapters:

Introduction

Meet Dr. Jeff Kerrie and learn about his journey in hyperbaric medicine and the unique setup of Vancouver Island’s hyperbaric program.

History of Hyperbaric Medicine

A look at the origins of hyperbaric therapy, from 1600s pressurized chambers to its modern evolution.

The Physiology of HBOT

Understanding the effects of supra-physiologic oxygen pressures on microcirculation, angiogenesis, and inflammation.

Indications and Evidence:

Decompression Sickness

The mechanisms of treating “the bends” and why HBOT works so effectively.

Air or Gas Embolism

Insights into diagnosing and treating air embolism, including critical resuscitation tips.

Carbon Monoxide Poisoning

How HBOT prevents long-term neurological damage, with considerations for pregnant patients and associated toxins like cyanide.

Necrotizing Soft Tissue Infections

The role of HBOT in treating Fournier’s gangrene and clostridial infections alongside surgery.

Crush Injuries and Anemia

Exploring HBOT’s utility in tissue salvage and sustaining oxygenation in severe anemia.

Newer Indications: Sudden Hearing and Vision Loss

The emerging role of HBOT in sudden sensorineural hearing loss and central retinal artery occlusion.

Risks and Safety in the Chamber

Barotrauma, oxygen toxicity, fire safety, and managing emergencies during dives.

Logistics of Hyperbaric Medicine

A behind-the-scenes look at hyperbaric chamber setups, patient care protocols, and equipment considerations.

Closing Thoughts

Dr. Kerrie’s perspective on the future of hyperbaric medicine and ongoing research opportunities.


Key Indications for HBOT:

1. Decompression sickness ("The Bends")

2. Air or gas embolism

3. Carbon monoxide poisoning

4. Necrotizing soft tissue infections

5. Crush injuries and compartment syndromes

6. Severe anemia (e.g., in patients unable to receive transfusions)

7. Radiation tissue injury (e.g., osteoradionecrosis)

8. Sudden sensorineural hearing loss


Resources and Links:

• Undersea and Hyperbaric Medical Society Approved Indications for Hyperbaric Oxygen Therapy - Oceanside Hyperbaric

• Hyperbaric Medicine | © 2018 The Royal College of Physicians and Surgeons of Canada. All rights reserved.


Disclaimer:

This episode provides general information and is not a substitute for professional medical advice. Always consult with a specialist for specific clinical decisions.


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11 months ago
30 minutes 33 seconds

The Critical Care Commute Podcast
The Critical Care Commute Podcast is grateful for your ears, insights and feedback. In return its hosts- Peter Brindley and Leon Byker, two ICU doctors in Alberta, Canada- offer up knowledge and debate with some of the most qualified, interesting, enlightened and provocative folks in Critical Care Medicine, and beyond. We strive to keep it practical and concise. Like you, our overriding goal is to get better, do better and feel better.