Terrific new analysis from Sarah Donnelly and Sean van Diepen UAlberta Crit Care in Circ: CQO

1. >4-fold variability in use of ICU Rx across 🏥🏥
2. Driven by pt-level factors & illness severity (~80% of variability)
3. Similar adjusted☠️irrespective of ICU Rx utilization rates

Excited to share our perspective in Journal of Cardiac Failure on Schrodinger’s Shock - an underappreciated challenge in conduction of cardiogenic shock trials - grateful to my co authors Ann Gage Sean van Diepen and Jason N. Katz as well as to Shashank Sinha, MD, MSc, FACC, FAHA for mentorship on the piece!

We looked at 7,812 survivors of AMI-CS, and compared them with survivors of AMI without shock.

The AMI-CS survivor population was sick:
Median MODS = 4
Invasive mechanical ventilation = 51.5%
Renal replacement therapy = 12.0%
IABP = 11.6%
Median ICU length of stay: 6 days

Understanding long-term outcomes in cardiogenic shock survivors is an important area of future research, and our new ICES paper looks at mental health outcomes in this population. Just published in Intensive Care Medicine.

🔓rdcu.be/dGDlC

link.springer.com/article/10.100…

I think this highlights the challenge with 2ary endpoints that don't have standardized initiation criteria that vary by physician/centre such as RRT, mech ventilation, tMCS escalation, or even destination therapies. Our prior #CCCTN work showed a 16% variation in CICU CRRT use

✍️ Revised expert opinion on cardiac arrest systems of care (see image ⬇️)
onlinecjc.ca/article/S0828-… #CJC 11/11 🔚

✍️ Revised expert opinion #2 on Temperature Control:
In patients who do not purposefully respond to verbal commands after a resuscitated OHCA with an initial non-shockable rhythm, it is reasonable to target a core temperature target of ≤ 37.5°C onlinecjc.ca/article/S0828-… #CJC 4/11

✍️ Revised expert opinion #1 on Temperature Control:
In patients who do not purposefully respond to verbal commands after a resuscitated OHCA with an initial shockable rhythm, it is reasonable to target a core temperature target of ≤ 37.5°C onlinecjc.ca/article/S0828-… #CJC 3/11

✍️ Revised expert opinion:
In comatose patients with a resuscitated OHCA without STEMI, delaying angiography might be considered unless there is hemodynamic instability, high-risk ischemic ECG changes, or recurrent ventricular arrhythmias onlinecjc.ca/article/S0828-… #CJC 2/11

📣 #Tweetorial : The CCS CANCARESociety Clinical Practice Update “Optimal Post Cardiac Arrest and Refractory Cardiac Arrest Patient Care” has been published. See all expert opinions here 👉 onlinecjc.ca/article/S0828-… #CJC 1/11 🧵

Updated cardiac arrest management guidelines based on latest RCts. Amazing work by Janek Senaratne Erin Rayner-Hartley Christopher Fordyce Graham Wong Emilie Belley-Côté, MD, PhD rebecca mathew CJC Journals Stanley Nattel

📝 This new CCS Clinical Practice Update provides 19 expert opinions on contemporary best practices for post-cardiac arrest care, the treatment of refractory cardiac arrest, and regionalized systems of care 👉 onlinecjc.ca/article/S0828-… #CJC

An incredible #ACC24

🫀1st time presenting on TTM
🫀sharing the stage with good friend Sean van Diepen
🫀PD/APD dream team w/Julie Damp
🫀Building Nashville connections w/Ann Gage
🫀Reconnecting with so many friends 🥰

Vanderbilt Health VUMC Heart/Vascular Vanderbilt Cardiology Fellowship Jane Freedman MD

Topical compared to IV tranexamic acid in patient undergoing CV surgery lowers risk of seizure but increases risk of RBC transfusion Jason N. Katz American College of Cardiology Shashank Sinha, MD, MSc, FACC, FAHA

I think Canadian centers will need to change practice, but costs of the pump remain a challenge.

REDUCE AMI. Evidence for de-ad option of BBlockers in lower risk patients with MI and preserved LV function. Patients will love taking 1 less pill! Shelley Zieroth Jason N. Katz Shashank Sinha, MD, MSc, FACC, FAHA Timothy Henry

Agree, The higher vascular complications expected, but the RRT and sepsis signals suggest a need to sort out if this is survival bias (allowing for more complications to occur) or if these are 'device specific.' Alex Truesdell Jason N. Katz Saraschandra Vallabhajosyula, MD MSc Ann Gage Carlos L. Alviar MD, FACC

Congrats to Danger team Christian Hassager! Impressive results, now after SHOCK and Culprit-Shock 3rd positive RCT. Nevertheless, multiple questions remain: 1) is it the device? 2) patient selection? 3) treatment bias? 4) longer follow-up? Sean van Diepen Johann Bauersachs Navin Kapur

I like the trial and the results. However, a treatment bias with more intensive care treatment as shown by the non-pathophysiological explainable RRT increase may also be a confounder of the trial results.

Sean van Diepen Shashank Sinha, MD, MSc, FACC, FAHA Shelley Zieroth Holger Thiele Abdulla A. Damluji, MD, PhD Alex Truesdell Michelle Graham Bravo to those investigators! A true endurance test. Patient selection most certainly matters for shock trials. They have given us a wonderful blueprint for future trials too!