Extracorporeal Support in Cardiogenic Shock - A Look at the Evidence with Dr Sean van Diepen

The Critical Care Commute Podcast

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In Her Ellement

1
Navigating Career Pivots and Grit with Milo’s Avni Patel Thompson 26:18

25 days ago26:18

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26:18

How do you know when it’s time to make your next big career move? With International Women’s Day around the corner, we are excited to feature Avni Patel Thompson, Founder and CEO of Milo. Avni is building technology that directly supports the often overlooked emotional and logistical labor that falls on parents—especially women. Milo is an AI assistant designed to help families manage that invisible load more efficiently. In this episode, Avni shares her journey from studying chemistry to holding leadership roles at global brands like Adidas and Starbucks, to launching her own ventures. She discusses how she approaches career transitions, the importance of unpleasant experiences, and why she’s focused on making everyday life easier for parents. [01:26] Avni's University Days and Early Career [04:36] Non-Linear Career Paths [05:16] Pursuing Steep Learning Curves [11:51] Entrepreneurship and Safety Nets [15:22] Lived Experiences and Milo [19:55] Avni’s In Her Ellement Moment [20:03] Reflections Links: Avni Patel Thompson on LinkedIn Suchi Srinivasan on LinkedIn Kamila Rakhimova on LinkedIn Ipsos report on the future of parenting About In Her Ellement: In Her Ellement highlights the women and allies leading the charge in digital, business, and technology innovation. Through engaging conversations, the podcast explores their journeys—celebrating successes and acknowledging the balance between work and family. Most importantly, it asks: when was the moment you realized you hadn’t just arrived—you were truly in your element? About The Hosts: Suchi Srinivasan is an expert in AI and digital transformation. Originally from India, her career includes roles at trailblazing organizations like Bell Labs and Microsoft. In 2011, she co-founded the Cleanweb Hackathon, a global initiative driving IT-powered climate solutions with over 10,000 members across 25+ countries. She also advises Women in Cloud, aiming to create $1B in economic opportunities for women entrepreneurs by 2030. Kamila Rakhimova is a fintech leader whose journey took her from Tajikistan to the U.S., where she built a career on her own terms. Leveraging her English proficiency and international relations expertise, she discovered the power of microfinance and moved to the U.S., eventually leading Amazon's Alexa Fund to support underrepresented founders. Subscribe to In Her Ellement on your podcast app of choice to hear meaningful conversations with women in digital, business, and technology.…

15 days ago 22:37

MP3•Laman utama episod

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!

74 episod

#Fitness #Medicine #Critical Care Commute

Extracorporeal Support in Cardiogenic Shock - A Look at the Evidence with Dr Sean van Diepen

The Critical Care Commute Podcast

published 15 days ago

Kongsi

MP3•Laman utama episod

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!

74 episod

#Fitness #Medicine #Critical Care Commute

Semua episod

1
The Present and Future of eCPR with Dr Darryl Abrams 29:14

3 days ago29:14

29:14

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…

1
Extracorporeal Support in Cardiogenic Shock - A Look at the Evidence with Dr Sean van Diepen 22:37

15 days ago22:37

22:37

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!…

1
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4 weeks ago44:06

44:06

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!…

1
Refractory Cardiac Arrest - A Clinical Practice Update with Dr Rebecca Mathew 25:17

7 weeks ago25:17

25:17

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.…

1
Clinical Practice Update on Optimal Post Cardiac Arrest and Refractory Cardiac Arrest Patient Care with Dr Janek Senaratne. 29:38

9 weeks ago29:38

29:38

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:…

1
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10 weeks ago24:07

24:07

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1
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14 weeks ago33:03

33:03

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1
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30:33

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30:38

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1
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Extracorporeal Support in Cardiogenic Shock - A Look at the Evidence with Dr Sean van Diepen