Eric Hall

We finished with an inspiring keynote by @melsulistio from @utswheart on humanity in medicine. The perfect bookend to an amazing conference. Thanks to all the organizers and speakers! @CardioNerds @CCCEnthusiasts #critcarecards24

Amazing panel discussion afterwards moderated by @AnnGageMD. Jacob Moller of DanGer Shock: "This was a first step... We really have to study how to manage these patients in the ICU." @CardioNerds @CCCEnthusiasts #critcarecards24

Great follow up talk by Christian Hassager of DanGer Shock on importance of pt selection for tMCS. Subgroups suggest largest benefit in pts w/ low MAP, multivessel dz, younger age, earlier randomization. @CardioNerds @CCCEnthusiasts #critcarecards24

Very interesting talk by Kurt Huber on heterogeneity in CS & limitations of observational data in tMCS. Benefit primarily in selected AMICS patients w/o risk of hypoxic brain injury. Recent C3TN paper showed 5% of CS pts fit DanGER Shock criteria. @CardioNerds #critcarecards2024

Keynote address by @glennfishman on "Why I support critical care cardiology". It's ultimately about patient outcomes! Also extremely important for program growth and an "absolute necessity" in this era. @CardioNerds @CCCEnthusiasts #critcarecards24

Panel discussion on high risk airway including @EBohula @LMethvinMD @carlosalviar @ElliottMillerMD - consider whether you truly have to intubate - consider awake tube w/ numbing + low dose fent/midaz - vasoactives hanging, +/- AV sheaths for ECMO @CardioNerds #critcarecards24

Great highlights by @LMethvinMD on CICU ventilator liberation 1. Daily screen for SBT 2. For pts on tMCS, consider whether they'll be able to sit up to protect airway 3. Optimize pre-extubation! 4.Have nipride ready, consider NIV @CardioNerds @CCCEnthusiasts #critcarecards24

Checklist for intubation in pts with CS by Guido Tavazzi: - make sure the IV works - art line - video laryngoscopy - all induction meds can ⬇️ hemodynamics, esp at high doses. He prefers low dose fentanyl, etomidate, and rocuronium @CardioNerds @CCCEnthusiasts #critcarecards24

Amazing pearls on post-cardiotomy RV failure by @AndreaElliottUM Unique causes of post-op RVF -inadequate cardioplegia (esp if only retrograde approach as in severe AI) - air embolism to RCA - surgical injury to RCA or LCx - protamine-induced PH @CardioNerds #critcarecards24

Great first talk by @Sam_Brusca on the RV 1. Most RV contraction is longitudinal; LV/septum contributes 40% 2. PAPI: good marker of RVPA coupling, cut-offs vary w chronicity 3. U-shaped relationship w PVR and lung vol, lowest at FVC @CardioNerds @CCCEnthusiasts #critcarecards24

We finished with a great session by Dr Courtney Bennett on noninvasive monitoring. Thanks to Dr Bennett, @AndreaElliottUM @JasonKatzMD @garima_d7 @YoavKarpenshif & many others for leading an amazing conference! Looking forward to the 2nd annual! @CardioNerds @UMN_CCCEdSummit

Very useful talk by @criticalecho followed by hands on session w/ PE devices. A few highlights: -syncope+PE is concerning -tPA often contradicted, 10-30% risk of major bleeding -multiple devices exist for catheter directed lysis or mech thrombectomy @CardioNerds @UMN_CCCEdSummit

Great discussion among CICU experts including @JasonKatzMD @jason_bartos @AnnGageMD (complete with a birthday cake for @carlosalviar ). Consensus on avoiding routine LV unloading, deep sedation. @CardioNerds @UMN_CCCEdSummit @YoavKarpenshif

Great case by @RickyHansra on pregnancy and ECMO. -pregnancy is a low SVR state, pts are afterload sensitive -commonly deliver by c-section -target SpO2>95% -CVP, PCWP ⬆️ w/ contractions -⬆️flows necessary to match ⬆️CO necessary @UMN_CCCEdSummit @CardioNerds @YoavKarpenshif

Really useful session on myocarditis. Have to consider the dx first. Early biopsy if unstable, high grade AVB, sustained VT + recent onset of sx. @UMN_CCCEdSummit @CardioNerds @YoavKarpenshif #CCCES2023

Great session w/ @WesElyMD and colleagues on rehumanizing care/icu liberation “Our job is to try to allow patients to get back to the life they had before the icu.” Keys=ABCDEF bundle,esp early mobility+minimizing sedation @CardioNerds @UMN_CCCEdSummit @JasonKatzMD @carlosalviar

EEGs in the CICU: -normal EEGs look like coarse VF -epileptiform activity = PVCs of the brain. Abnormal synchronous firing of neuron groups -seizures are like VT. Repetitive synchronous depolarizations. -status needs emergent tx w/in min #CCCES2023 @CardioNerds @UMN_CCCEdSummit

Great talk by @carlosalviar on heart-lung interactions in the CICU -PPV ⬆️ RV afterload, ⬇️ preload and LV afterload -delayed MV associated with ⬇️ survival in CS -avoid hyperoxia -PEEP ⬇️ MR, high PEEP ⬆️PVR -avoid SIMV @UMN_CCCEdSummit @CardioNerds @YoavKarpenshif @JasonKatzMD

ECPR tips from @jason_bartos -Goal 6-8min from pt arrival to ecmo flow -15-17F arterial, 25F venous -U/s access with fluoro confirmation -DPC for all pts @CardioNerds @UMN_CCCEdSummit @YoavKarpenshif @JasonKatzMD

Take aways from the afternoon -consider TEE during arrest for multiple reasons including hand placement during compression (avoid the LVOT) -subclavian access with ultrasound is very useful. And so is lung u/s @CardioNerds @UMN_CCCEdSummit @YoavKarpenshif