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 & ChaptersMike’s Career JourneyFrom paramedic to physician: an unconventional pathMilitary and aviation medicine experienceThe shift to leadership in pre-hospital carePre-Hospital Critical Care: Canada vs. The WorldHow Canada’s HEMS (Helicopter Emergency Medical Services) differs from global modelsLessons from the UK, Australia, and DenmarkThe role of AI in dispatch and triageThe Role of Physicians in Pre-Hospital MedicineThe evolving need for physician-led care outside the hospitalThe impact of interprofessional teams on survival ratesMentorship, coaching, and cultural change in pre-hospital systemsThe Role of the Physician in Pre Hospital Medicine. AI-powered dispatch and GoodSAM app in improving CPR and trauma responseScoop and run vs. stay and play: What actually saves lives?Addressing Canada’s geographical challenges with rural and remote careFuture Directions in Pre-Hospital MedicineThe rise of telemedicine and virtual ICUsDeveloping triage physicians and training programsMedResponse BC: A new model for interprofessional pre-hospital careKeywords: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: CCCF Presentation:  https://youtu.be/MVDHaYaZRSI  (Web view)Recent Publication:  https://doi.org/10.1186/s13049  (Web view)

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• 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 Welcome01:08 Personal Experience with Sexual Harassment03:06 Understanding Gender Based Harassment in Medicine05:34 Organizational Factors and Solutions07:50 Gender Disparities in Academic Medicine17:42 Impact on Trainees and Reporting Challenges24:46 Addressing Patient-Perpetrated Harassment28:59 Practical Strategies and Training32:26 Conclusion and Call to Action

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• 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:00:00Introduction 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

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  30:07
• 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 welcomeSetting the scene: What is eCPR and why now?The ARREST trial: Small study, big impactThe Prague OHCA trial: Early randomization, broader populationThe INCEPTION trial: Multicenter reality and negative resultsComparing the evidence: Why do outcomes differ?Low-flow time and speed of cannulationThe role of meta-analyses and what they do (and don’t) tell usOpportunity cost: What are we giving up to fund eCPR?Duration of support: How long is too long?Will there be another trial? Challenges of equipoiseBuilding a responsible eCPR programPatient selection: Who qualifies and why?Cannulation techniques and adjunct devicesSystem design: U.S. vs. Canada vs. U.K.Ethical concerns and access inequitiesGuidelines and final takeaways

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• 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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