The Critical Care Commute Podcast

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.

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)

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

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

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

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.

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 Overview02:56 Early Career and Influences06:25 Pioneering Emergency Medicine in the Military08:13 Revolutionizing Combat Casualty Care17:55 International Collaboration and Cultural Insights30:31 Leadership in Crisis35:35 Coping with Trauma and Personal Reflections39:43 Retirement and Legacy42:29 Conclusion and Final ThoughtsThis 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!

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 changeReferences: 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.

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:

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.

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

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.

In this episode, Peter Brindley and Leon Byker sit down with Dr. Rob Bevan, immediate past president of the College of Intensive Care Medicine (CICM) and Critical Care Director at Auckland City Hospital, Auckland, New Zealand. Dr. Bevan shares his journey through leadership in intensive care, the role of intensive care colleges, and the evolution of critical care training. He also explores the political, social, and ethical dimensions of critical care, from workforce sustainability to the unique role of intensivists as brokers of care. Episode Highlights: The Evolution of CICM: History of the CICM and the differences between the CICM and similar organizations globally. Training for Critical Care: The training pipeline in Australasia. Advocacy and Political Engagement: The role of the CICM in advocating for intensive care resources. The Value of College Convocations: Celebrating new fellows and their families and the role of meaningful ceremonies. The Intensivist as a Broker of Care: Defining the role of the ICU specialist in complex patient care. The Future of Critical Care Workforce: Addressing workforce challenges and it's sustainability. The Upcoming CICM Annual Meeting: Highlights of the upcoming 2025 meeting in Tasmania. Reflections on Leadership and Administration: Dr Bevan's Journey into administration and why it matters.

Coping with dying and saying what needs to be heard: Elliot Sprague Introduction: In this emotional episode, Peter Brindley, Leon Byker, and Elliot Sprague revisit Elliot's journey with metastatic cancer, a year after his initial appearance on the podcast, Elliot reflects on the impact of living with a terminal illness, sharing life lessons, and offering insights on how he continues to thrive despite a difficult prognosis. This episode Elliot talks about acceptance, gratitude, and the importance of living each moment fully. Topics Discussed: Elliot's cancer journey since his last appearance. Transition from curative treatment to a palliative diagnosis. The emotional challenges of facing terminal illness. Acceptance of reality and choosing how to live each day. The role of gratitude in maintaining emotional well-being. Coping with the loss of professional identity. Legacy-building and leaving meaningful gifts for loved ones. The importance of honest conversations about death. Support systems: family, friends, and the medical community. Practical tools for mindfulness and mental well-being. Timeline: 00:00 - 01:30: Introduction and re-welcoming Elliot Sprague to the show. 01:31 - 05:20: Elliot updates on his cancer journey, including treatment successes and setbacks. 05:21 - 10:00: The shift from a curative approach to palliative care. 10:01 - 15:45: Acceptance, gratitude, and how Elliot thrives with his diagnosis. 15:46 - 20:55: Discussing HyPEC surgery and reflecting on end-of-life realities. 20:56 - 25:30: Legacy-building, gratitude practice, and leaving meaningful messages for loved ones. 25:31 - 30:10: Coping with family grief and how Elliot's wife Danielle plays a crucial role. 30:11 - 35:50: The power of mindfulness in Elliot's journey and how it changed his outlook. 35:51 - 40:15: The role of humor and connection in facing terminal illness. 40:16 - 45:00: Final reflections, messages of gratitude, and an emotional conclusion. Thank you Elliot for joining us! https://www.gofundme.com/f/dr-elliott-sprague-and-family?attribution_id=sl:c52d4c83-2649-4ce0-a003-651776f01205&utm_campaign=man_sharesheet_ft&utm_medium=customer&utm_source=email

In this episode, we sit down with Dr. Damon Scales and Dr. Niall Ferguson at the Canadian Critical Care Forum. We dive into a little bit of ARDS and spend a whole lot of time talking about the evolving landscape of conferences and critical care research. Tune in for insights from two leaders in the field!

Join us as Prof. Stephen Lapinski answers our questions on Obstetric critical care. Stephen Lapinsky is Director of the Intensive Care Unit at Mount Sinai Hospital, Toronto and Professor of Medicine at the University of Toronto. He graduated from the University of the Witwatersrand, Johannesburg, and trained in Pulmonary and Critical Care Medicine. His clinical practice includes general Critical Care Medicine and ambulatory Respirology. He has a clinical and research interest in critical illness and respiratory disease in the pregnant patient. He is an officer of the North American Society of Obstetric Medicine (NASOM) and is co-Editor-in-Chief of the international journal Obstetric Medicine.

Join us as we discuss ARDS, Research and balancing life as a researcher with Professor Charlotte summers, Director of the Heart and Lung Research Institute (HLRI).

Join James Downar Head of Palliative and End of Life Care and a Critical Care Doc in Ottawa. He has walked the walk on this topic since before its introduction in Canada. Nobody is better qualified to discuss this thorny topic. 

Join Brian Buchanan, Associate Professor and ultrasound guru, for a dose of iconoclasm and provocation. Recorded at the Critical Care Canada Forum in Toronto, and following a 2024 JICS publication by Brindley et al.  

Thank you for your patience! After a short break, we are back with a delightful interview with Dr. Jeff Drazen, the esteemed former Editor-in-Chief of the New England Journal of Medicine (NEJM). In this episode, we explore the critical journey of transforming medical research into practical, patient-and-family centered care. We emphasize the importance of bringing humanity back into healthcare and ensuring that scientific advancements translate into meaningful outcomes for patients and families, right at the bedside. Listen as we explore modern forms of knowledge translation, the challenges they pose, and how healthcare professionals can navigate these complexities to enhance patient care. With a distinguished career at the helm of one of the world's leading medical journals, Dr. Drazen's episode is one that you don't want to miss!

Welcome to the Critical Care Commute Podcast! In this episode, we have the honor of hosting Dr. Dan Howes. Dr. Howes is a Professor in the Departments of Critical Care Medicine and Emergency Medicine. He is the founder and director of the Kingston Resuscitation Institute and initiated the first Fellowship in Resuscitation and Reanimation through the Department of Emergency Medicine at Queen's. Join us as we explore how simulation in medical training is revolutionizing the way healthcare professionals prepare for high-stakes scenarios. We'll also dive into the principles of stoicism and how this ancient philosophy can enhance resilience and decision-making under pressure. Finally, we'll discuss the latest insights from cognitive science and how they can be applied to improve performance and outcomes in critical care settings. Whether you're a healthcare professional, a student, or simply curious about these compelling topics, this episode promises to be an enlightening journey into the cutting-edge strategies that are shaping the future of medical practice. Stay tuned, and let's get started!

https://portal.cicm.org.au/asm-event/

We return to our Canadian Critical Care Forum series with this episode. In this episode, we delve into the world of Extracorporeal Membrane Oxygenation (ECMO) with Dr. Eddy Fan, a leading expert in critical care and ECMO specialist. Eddy Fan is an associate professor in the Interdepartmental Division of Critical Care Medicine and the Institute of Health Policy, Management, and Evaluation at the University of Toronto and a staff intensivist at the University Health Network/Mount Sinai Hospital. Dr. Fan received his undergraduate degree from the University of Toronto, his medical degree from the University of Western Ontario, and a PhD in Clinical Investigation from Johns Hopkins University. He is currently the Medical Director of the Extracorporeal Life Support Program at the Toronto General Hospital, and the Director of Critical Care Research at the University Health Network/Mount Sinai Hospital. Dr. Fan's research has focused on advanced life support for acute respiratory failure and patient outcomes from critical illness. These include investigations on the epidemiology and use of mechanical ventilation and extracorporeal life support in patients with ARDS, as well as on the development of ICU-acquired weakness, early rehabilitation in ICU patients, and long-term outcomes in survivors of critical illness. Join us as we take on this huge topic.

We take a quick break from our Canada Critical Care Forum series, for a special episode. We had the privilege of hosting Dr. Rob Fowler, visiting professor at the University of Alberta as part of the Dr. Noel Gibney lecture series. Dr. Fowler is a critical care physician and Tory Trauma Program Chief at Sunnybrook Hospital and Chair of the Canadian Critical Care Trials Group. Rob's academic interests include access and outcomes of care for critically ill patients and those near the end of life – in a global context. He has assisted or worked with national and international health care organizations during SARS, pandemic and avian influenza, Middle East Respiratory Syndrome, Ebola and COVID-19. Dr. Fowler shared invaluable insights into the concept of "Critical Care Without Borders," emphasizing the universal principles and challenges inherent in critical care medicine. Throughout the episode, Dr. Fowler's passion for improving patient care and his commitment to advancing critical care education and research were evident. Tune in to this enlightening conversation as we explore the boundless possibilities and inherent responsibilities of providing Critical Care Without Borders.

In this episode, join us for an in-depth conversation with Dr. Andrew Baker, as he reflects on his time as the incident Commander of the Ontario Critical Care COVID Command Centre, during the COVID pandemic. Dr. Baker offers a firsthand account of the establishment and operation of this crucial hub in the battle against the pandemic, highlighting the collaborative efforts of healthcare professionals, policymakers, and community leaders. Dr. Andrew Baker is the Chief of the Departments of Critical Care and of Anesthesia, and the Medical Director of the Surgery and Critical Care Program at St. Michael's Hospital, Unity Health Toronto. Tune in as we uncover the dedication, innovation, and resilience driving our collective response to this unprecedented crisis.

Welcome to our latest episode, recorded live at the Critical Care Forum in Canada. We're joined by Dr. Stephanie Sibley and Dr. Michal Cwhalek, a Critical Care Trainee, to discuss Atrial Fibrillation, the most commonly sustained cardiac arrhythmia in critical care. Dr Stephanie Sibley is an Assistant Professor in the Department of Critical Care Medicine at Queens University, Kingston, Canada. Her research interests include new onset atrial fibrillation in critically ill patients where she is developing methods for better quantifying atrial fibrillation burden using electronic monitoring, prevention and treatment strategies and determination of long-term atrial fibrillation outcomes.  Join us as we delve into the clinical importance, management approaches, and potential complications of AF in critically ill patients.

Welcome to the 2nd episode in our Critical Care Forum Canada 2023 podcast series, where we interview leading Canadian experts. In this episode, we explore the intersection of artificial intelligence and critical care medicine with Dr. Shelly Dev and David Maslove, recorded after a panel discussion held at the Conference in Toronto. Dr Dev is no stranger to our podcast and is a staff intensivist at Sunnybrook Health Sciences Centre, Toronto, Canada, where she serves as the director of education for Critical Care Medicine. Dr Maslove is a Clinician Scientist and Intensivist at Queen's University, Kingston, Canada. His research focuses on the use of physiologic and genomic data to advance precision medicine in the ICU.

Welcome to the inaugural episode of our podcast series, recorded live at the Critical Care Canada Forum meeting of 2023. In our first episode, we are again joined by the esteemed Dr. Hannah Wunsch, expert in critical care medicine with a keen interest in the historical lessons we can glean from medical breakthroughs of the past. Today, we will continue exploring the lessons from the fight against polio and they shaped modern critical care practices. This is just the beginning, so buckle up and get ready to be inspired as we interview Dr. Hannah Wunsch and many more Canadian Critical Care luminaries, recorded live at the Critical Care Canada Forum meeting of 2023.

Welcome to our first episode of season three! We are kicking off with what is probably one of the most important topics to be discussed in modern medicine today: The rational use of antibiotics. In this episode, we have the honor of hosting Dame Sally Davies, a renowned figure in global public health and former Chief Medical Officer for England. Dame Sally has been a leading voice in advocating for the rational use of antibiotics to combat antimicrobial resistance. Join us as we sit down with Dame Sally Davies to explore the intricacies of antibiotic stewardship and the urgent need for global action. Throughout our conversation, we'll delve into the complexities surrounding antibiotic use, discussing the challenges of over prescribing, the rise of drug-resistant infections, and the implications for both human and animal health. This is a conversation you won't want to miss.

In our latest episode, we sat down with Dr. Neil Spenceley, pediatric intensivist and Safety expert. Listen as Dr. Spenceley unpacks safety and proposes a shift from a binary safety approach (safety 1 and safety 2) to resilient engineering and system performance. Dr. Neil emphasizes the holistic view encompassing efficiency, efficacy, safety, and staff well-being. Drawing from incidents like Three Mile Island, he emphasizes the role of human factors in identifying and resolving issues, understanding work as work is done and the importance of understanding frontline work realities to bridge gaps between protocols and real-world scenarios, advocating for system redesign to reduce complexity. We hope you enjoy this episode!

Welcome to our next episode! In this episode, we again delve into the world of neuroprognostication with none other than Dr. Julie Kromm. Dr Kromm is a neurointensivist, who brings a wealth of expertise to the table and was one of the authors on the Canadian Position Statement for Neuro Prognostication after cardiac arrest. Neuroprognostication is a field that combines the precision of neurology with the nuances of predicting outcomes in patients with severe neurological injury after cardiac arrest. Join us as Dr. Kromm guides us through looking behind the fog, using the physical examination appropriately and what to make of special testing. Further Reading: 1. Neuroprognostication in the Post Cardiac Arrest Patient: A Canadian Cardiovascular Society Position Statemen. https://doi.org/10.1016/j.cjca.2022.12.014

Welcome to another episode of "The Critical Care Commute" podcast! In this episode, Peter Brindley and Leon Byker sit down with special guest Elliot Sprague. Elliot Sprague is an internist known for his unique perspective on healthcare and his remarkable journey through a recent health challenge. In this episode, Elliot reflects on the shock of being diagnosed with a metastatic malignancy and how it changed his life. He discusses the impact of being present, engaged, and honest with patients, and how it has positively influenced his own well-being. Elliot also delves into the emotional side of life, sharing how he encourages his son to express and deal with his feelings, describes the importance of naming and acknowledging emotions thus fostering a healthy approach to fear and anxiety. Tune in to this episode for a profound conversation about life, medicine, and finding joy in the face of adversity. Elliot Sprague's unique perspective serves as an inspiration to both healthcare professionals and listeners navigating their own journeys. Thank you for joining "The Critical Care Commute" podcast!

Welcome to the Critical Care Commute Podcast, as we delve into the world of healthcare communication with one of the most esteemed voices in the field – Andre Picard. Andre Picard, a renowned health columnist for The Globe and Mail, brings his wealth of knowledge and experience, providing insights into the vital role that effective communication plays in the world of healthcare. From doctor-patient interactions to public health messaging, Picard offers a unique perspective on how communication shapes our understanding of health issues and influences decision-making at both individual and societal levels. In this episode, we explore the impact of media on healthcare perceptions, the role of social media in shaping health narratives, and the challenges of conveying accurate information in an era of misinformation. Join us for a thoughtful exploration of the nuances in healthcare communication, as we seek to enhance our understanding of the crucial link between effective communication and the overall well-being of individuals and communities.

Welcome back to our second podcast from sunny San Diego! Stay classy, San Diego! Peter and Leon are again joined by Matteo, Jarrod, and Calvin for rapid fire cases! In this episode they discuss approaches to: Rapid Fire Scenario 1 - Tracheostomy tube displacement. Rapid Fire Scenario 2 - Hypoxemic patient going into Cardiac arrest Topicalization Techniques Handling the Soiled Airway - Video Laryngoscopy vs. Direct Laryngoscopy. Join us as the team reflects on the benefits of spending time immersed in difficult airway scenarios. Airway management goes beyond mere intubation and involves cognitive skills, team management, and situational awareness. The Difficult Airway Course is a valuable experience for those interested in enhancing their airway management skills.

In this episode, we have the privilege of hosting three luminaries in the field of airway management: Drs. Jarrod Mosier, Calvin Brown, and Matteo Parotto. As distinguished leaders from the Difficult Airway Course, they bring incredible insights to managing the acute care airway. Whether you're a seasoned practitioner or a healthcare enthusiast, their collective knowledge promises to deepen your understanding and appreciation for the art and science of airway management. Tune in as they share their experiences, innovations, and vision for the future of airway management. https://www.theairwaysite.com/

Welcome to the Critical Care Commute Podcast! In today's episode, we delve into the field medical education. Joining us is Dr. Chris Nickson, to explore the question: "Are we training intensivists for the future?" As advancements in medical technology and our understanding of critical care continue to evolve, it's essential to assess whether our current training programs adequately equip intensivists with the skills and knowledge needed for the challenges ahead. Dr. Chris Nickson, with his wealth of experience and insights, provides a deep dive into the current state of intensive care training, identifies potential gaps, and offers valuable perspectives on how we can better prepare the next generation of intensivists. Whether you're a healthcare professional, a medical student, or someone interested in the future of critical care, this episode promises to be enlightening and thought-provoking. Tune in as we navigate the landscape of intensive care training and explore the measures needed to ensure that intensivists are well-prepared to meet the demands of the ever-evolving healthcare landscape.

Welcome to the Critical Care Commute Podcast! In this episode, we are delighted to be joined by Dr. Alika Lafontaine, a trailblazing physician, advocate, and leader in Canadian healthcare. Dr. Lafontaine is not only a prominent anesthesiologist and physician leader, but also an influential voice in championing Indigenous perspectives within the broader healthcare system. His journey is one of dedication and overcoming, both characteristics that shaped his career into one of sheer brilliance. Dr. Lafontaine has been at the forefront of initiatives aimed at bridging gaps in Indigenous health outcomes. He is currently the immediate past-President of the Canadian Medical Association. Join us in this enlightening conversation as we delve into what matters to Dr. Lafontaine. His insights are sure to inspire, educate, and challenge our understanding of what it means to provide truly inclusive and effective healthcare for all. So, without further ado, let's dive into this interview with Dr. Alika Lafontaine!

In the grand finale of our "State of the Art 2023" series, we delve into the field of Neuro Critical Care research. We had the privilege of sitting down with renowned Professor David Menon, a leading authority in Neuro Intensive Care. Don't miss this final episode in our series, where we journey into learning lessons from large collaborations. This episode is a must-listen.

Here it is! The penultimate episode in our "State of the Art" series. Join Peter and distinguished guests, Prof. Mervyn Singer and Dr. Martin Beed as they discuss the world of sepsis and the impact of COVID-19 on ICU trials.

Welcome to another episode in our "State of the Art" series. We are joined by Dr Ronan O'Leary, Consultant and Specialty Lead in Neurosciences and Trauma Critical Care at Cambridge University. Dr. O'Leary brings a wealth of knowledge and experience to the table, making him the perfect guide for our journey through this fascinating and often life-changing field.

Welcome to the Critical Care Commute, the podcast where we explore the ever-evolving world of critical care medicine, one conversation at a time. In this episode, we're honored to have a distinguished guest who has dedicated her career to getting it right the first time in critical care. Joining us is Dr. Anna Batchelor, an expert in the field with a wealth of experience and insights to share. Join us for an enlightening conversation, as we explore the art and science of "Getting it Right the First Time" . Whether you're a healthcare professional, a student, or someone passionate about healthcare, this episode is bound to provide valuable insights. Thank you for tuning in to the Critical Care Commute. If you enjoyed this episode, please consider leaving a review and sharing it with your colleagues and friends. Stay tuned for more thought-provoking discussions in the realm of critical care medicine. [Disclaimer: The information provided in this podcast is for educational and informational purposes only and should not be considered as medical advice. Consult with a qualified healthcare professional for any medical concerns or questions.]

Welcome back to the Critical Care Commute as we continue our “State of the Art 2023” series. In today's episode, we have a distinguished guest who needs no introduction in the field of Advanced Cardiac Life Support (ACLS). Joining us today is Professor Jerry Nolan, a renowned expert and thought leader in resuscitation science and ACLS guidelines. Join us for an insightful and informative conversation with Professor Jerry Nolan as we delve deep into the world of ACLS guidelines, resuscitation science, and the critical role they play in saving lives. Whether you're a healthcare professional or simply interested in the field, this episode is a must-listen. Thank you for tuning in to the Critical Care Commute. If you enjoyed this episode, please consider leaving a review and sharing it with your colleagues and friends. Stay tuned for more fascinating discussions in the world of healthcare and medicine. [Disclaimer: The information provided in this podcast is for educational and informational purposes only and should not be considered as medical advice. Consult with a qualified healthcare professional for any medical concerns or questions.]

We are back with our "State of the Art" series! Join us as we talk to Dr. Nandy Gautam on the COVID experience in Birmingham, UK, and the Post-COVID syndrome. Dr. Gautam is a specialist physician and ICU consultant at the Queen Elizabeth Hospital, Birmingham, UK. In this episode, he takes us through his COVID experience working in this very busy Centre during the pandemic, and highlights the Post COVID syndrome experienced in their follow up clinic. Further Reading: www.postcovidsyndromebsol.nhs.uk www.yourcovidrecovery.nhs.uk www.physiotherapyforbpd.org.uk Stockley, James & Alhuthail, Eyas & Coney, Andrew & Parekh, Dhruv & Geberhiwot, Tarekegn & Gautam, Nandan & Madathil, Sc & Cooper, Brendan. (2021). Lung function and breathing patterns in hospitalised COVID-19 survivors: a review of post-COVID-19 Clinics. Respiratory Research. 22. 10.1186/s12931-021-01834-5.

Join us as we take a brief break from our State of the Art series as we speak to Dr. Blair Bigham about death and the complexities that life sustaining therapies bring when there is dwindling hope. Blair is an award-winning journalist, scientist and physician who trained in emergency and critical care medicine at McMaster and Stanford Universities. He was a Global Journalism Fellow at the Munk School of Global Affairs and Associate Scientist at St Michael's Hospital.  His work has appeared in newspapers, magazines, newscasts, podcasts and medical journals. He is co-host of the CMAJ Podcast. He witnesses the relationship between wealth and health on a daily basis, and reports on the undertold stories of patients, healthcare providers, and the systems that help or fail them. His first book, Death Interrupted: How modern medicine is complicating the way we die became a best-seller. https://youtu.be/CxdDaFoBYXA

Join us on our next podcast in the "State of the Art" series, as we delve into the realm of sustainability and climate change, guided by the wisdom and insights of Professor Hugh Montgomery. In this podcast, Professor Hugh Montgomery challenge us to think critically, act responsibly, and embrace the urgent imperative of creating a sustainable and resilient future for all. Who is Professor Hugh Montgomery? Read here: Hugh Montgomery (physician) - Wikipedia

Welcome to another episode in our "State of the Art Series". In this episode, we have the privilege of delving into the world of ARDS with a true pioneer in the field. Join us as we sit down with Professor Danny McAuley to unravel the complexities of ARDS – from its underlying mechanisms to the latest advancements in diagnosis and treatment. Professor McAuley's major interest is Acute Respiratory Distress Syndrome (ARDS). His research strategy in ARDS is to investigate potential novel therapeutic agents in ARDS in vitro, in vivo in human models of ARDS and in phase 2 clinical trials to inform subsequent phase 3 clinical trials. He is currently investigating the role of MSCs, statins and ECCO2R in ARDS.

Join us on this episode as Dr. Laura Vincent discusses what a good day looks like , for ICU staff. Dr. Vincent is a Consultant in Critical Care and Anaesthesia at Oxford University Hospitals (OUH). She is the simulation and education lead for critical care at OUH and is passionate about multi-disciplinary medical education, with particular focus on human factors, patient safety and the link to staff wellbeing. She is an active faculty member of OxSTaR simulation centre, University of Oxford and delivers human factors and patient safety training.

In this episode we welcome back good friend, Dr. Matt Morgan. Dr. Morgan is a Consultant in Intensive Care Medicine at the University Hospital of Wales, UK and The Royal Perth Hospital, Australia. He is an adjunct Clinical Professor at Curtin University, an Honorary Senior Research Fellow at Cardiff University and regular columnist at the BMJ. In his off time, he has penned 2 books thus far. In his is first book “Critical" he tells the remarkable stories of patients he has met as a guide through the intensive care unit. His second book, "One Medicine", explores how understanding the lives of animals can help treat human disease. In this episode, recorded remotely from Perth, Australia, Matt highlights animal physiology to help understand respiratory therapies in the ICU.

In this episode, we are joined by Professor Hugh Montgomery, leading expert in intensive care medicine, and Dr Jessica Sullivan, Anaesthetic/ITU Registrar. Listen as they share their insights on a challenging clinical scenario: hypoxemia with a normal chest X-ray. What are the pitfalls and pearls of managing hypoxemia with a normal chest X-ray? How has COVID-19 changed our understanding of this phenomenon? Professor Montgomery practices as a consultant in intensive care at the Whittington hospital in North London. His interest has been in the use of environmental stressors in the exploration of human (patho)physiology – often using a genetic approach. He was the first to discover a 'gene for human fitness'. He has published over 450 articles. He also has a strong interest in environmental impacts on health, and in climate change in particular. Dr Jessica Sullivan's most recent position was as an Anesthetic/ITU Registrar at the Whittingtoin Hospital, where she worked alongside Prof Montgomery. She is on the organizing committee for the North Thames Anaesthetic Meeting (NTAM) conference. Medicine is not her only passion, she is a keen sportswoman and an ex competitive gymnast. She is currently undertaking training in acrobatics. Learn more here: Hugh Montgomery (physician) - Wikipedia AirCraft Circus Academy aerial circus & studio hire, Greenwich, London – AirCraft Circus Academy Performance & Circus Training in London

Welcome to our next podcast in the "State of the Art 23" series. Listen as we talk POCUS and all things Focused Ultrasound for Intensive Care (FUSIC). In this episode, we hare joined by awesome guests: Dr. Marcus Peck, a consultant in anaesthesia and intensive care medicine at Frimley Park Hospital and sits on the board of the Intensive Care Society (ICS)'s Focused Ultrasound for Intensive Care (FUSIC) committee; and Dr. Jonny Wilkinson, a consultant in intensive care medicine and anaesthesia at Northampton General Hospital. So sit back, relax, and enjoy the show!" Further reading: 1. SONO-Olympiad - CAEP Conference 2. FUSIC HD. Comprehensive haemodynamic assessment with ultrasound - Ashley Miller, Marcus Peck, Tom Clark, Hannah Conway, Segun Olusanya, Nick Fletcher, Nick Coleman, Prashant Parulekar, Jonathan Aron, Justin Kirk-Bayley, Jonathan Nicholas Wilkinson, Adrian Wong, Jennie Stephens, Antonio Rubino, Ben Attwood, Andrew Walden, Andrew Breen, Manprit Waraich, Catherine Nix, Simon Hayward, 2022 (sagepub.com)

Professor Dan Martin is one busy, productive, chap. This Consultant in anaesthesia and intensive care is also the Editor-in-chief for the journal JICS. His research focuses on how we adapt to low oxygen and the harm from excessive oxygen. This has included several expeditions with the Xtreme Everest team. He is the chief investigator for the UK-ROX trial and EXAKT study. He also studies how exercise can improve clinical outcomes (including liver transplantation; the EXALT trial). He was awarded an OBE for prevention of infectious diseases and caring for those with Ebola. https://www.plymouth.ac.uk/alumni/invenite/the-big-interview-professor-daniel-martin-obe