Podcasts about Impella

Listen to JCO's Art of Oncology article, "The Man at the Bow" by Dr. Alexis Drutchas, who is a palliative care physician at Dana Farber Cancer Institute. The article is followed by an interview with Drutchas and host Dr. Mikkael Sekeres. Dr. Drutchas shares the deep connection she had with a patient, a former barge captain, who often sailed the same route that her family's shipping container did when they moved overseas many times while she was growing up. She reflects on the nature of loss and dignity, and how oncologists might hold patients' humanity with more tenderness and care, especially at the end of life. TRANSCRIPT Narrator: The Man at the Bow, by Alexis Drutchas, MD  It was the kind of day that almost seemed made up—a clear, cerulean sky with sunlight bouncing off the gold dome of the State House. The contrast between this view and the drab hospital walls as I walked into my patient's room was jarring. My patient, whom I will call Suresh, sat in a recliner by the window. His lymphoma had relapsed, and palliative care was consulted to help with symptom management. The first thing I remember is that despite the havoc cancer had wreaked—sunken temples and a hospital gown slipping off his chest—Suresh had a warm, peaceful quality about him. Our conversation began with a discussion about his pain. Suresh told me how his bones ached and how his fatigue left him feeling hollow—a fraction of his former self. The way this drastic change in his physicality affected his sense of identity was palpable. There was loss, even if it was unspoken. After establishing a plan to help with his symptoms, I pivoted and asked Suresh how he used to spend his days. His face immediately lit up. He had been a barge captain—a dangerous and thrilling profession that took him across international waters to transport goods. Suresh's eyes glistened as he described his joy at sea. I was completely enraptured. He shared stories about mornings when he stood alone on the bow, feeling the salted breeze as the barge moved through Atlantic waves. He spoke of calm nights on the deck, looking at the stars through stunning darkness. He traveled all over the globe and witnessed Earth's topography from a perspective most of us will never see. The freedom Suresh exuded was profound. He loved these voyages so much that one summer, despite the hazards, he brought his wife and son to experience the journey with him. Having spent many years of my childhood living in Japan and Hong Kong, my family's entire home—every bed, sheet, towel, and kitchen utensil—was packed up and crossed the Atlantic on cargo ships four times. Maybe Suresh had captained one, I thought. Every winter, we hosted US Navy sailors docked in Hong Kong for the holidays. I have such fond memories of everyone going around the table and sharing stories of their adventures—who saw or ate what and where. I loved those times: the wild abandon of travel, the freedom of being somewhere new, and the way identity can shift and expand as experiences grow. When Suresh shared stories of the ocean, I was back there too, holding the multitude of my identity alongside him. I asked Suresh to tell me more about his voyages: what was it like to be out in severe weather, to ride over enormous swells? Did he ever get seasick, and did his crew always get along? But Suresh did not want to swim into these perilous stories with me. Although he worked a difficult and physically taxing job, this is not what he wanted to focus on. Instead, he always came back to the beauty and vitality he felt at sea—what it was like to stare out at the vastness of the open ocean. He often closed his eyes and motioned with his hands as he spoke as if he was not confined to these hospital walls. Instead, he was swaying on the water feeling the lightness of physical freedom, and the way a body can move with such ease that it is barely perceptible, like water flowing over sand. The resonances of Suresh's stories contained both the power and challenges laden in this work. Although I sat at his bedside, healthy, my body too contained memories of freedom that in all likelihood will one day dissipate with age or illness. The question of how I will be seen, compared to how I hoped to be seen, lingered in my mind. Years ago, before going to medical school, I moved to Vail, Colorado. I worked four different jobs just to make ends meet, but making it work meant that on my days off, I was only a chairlift ride away from Vail's backcountry. I have a picture of this vigor in my mind—my snowboard carving into fresh powder, the utter silence of the wilderness at that altitude, and the way it felt to graze the powdery snow against my glove. My face was windburned, and my body was sore, but my heart had never felt so buoyant. While talking with Suresh, I could so vividly picture him as the robust man he once was, standing tall on the bow of his ship. I could feel the freedom and joy he described—it echoed in my own body. In that moment, the full weight of what Suresh had lost hit me as forcefully as a cresting wave—not just the physical decline, but the profound shift in his identity. What is more, we all live, myself included, so precariously at this threshold. In this work, it is impossible not to wonder: what will it be like when it is me? Will I be seen as someone who has lived a full life, who explored and adventured, or will my personhood be whittled down to my illness? How can I hold these questions and not be swallowed by them? "I know who you are now is not the person you've been," I said to Suresh. With that, he reached out for my hand and started to cry. We looked at each other with a new understanding. I saw Suresh—not just as a frail patient but as someone who lived a full life. As someone strong enough to cross the Atlantic for decades. In that moment, I was reminded of the Polish poet, Wislawa Szymborska's words, "As far as you've come, can't be undone." This, I believe, is what it means to honor the dignity of our patients, to reflect back the person they are despite or alongside their illness…all of their parts that can't be undone. Sometimes, this occurs because we see our own personhood reflected in theirs and theirs in ours. Sometimes, to protect ourselves, we shield ourselves from this echo. Other times, this resonance becomes the most beautiful and meaningful part of our work. It has been years now since I took care of Suresh. When the weather is nice, my wife and I like to take our young son to the harbor in South Boston to watch the planes take off and the barges leave the shore, loaded with colorful metal containers. We usually pack a picnic and sit in the trunk as enormous planes fly overhead and tugboats work to bring large ships out to the open water. Once, as a container ship was leaving the port, we waved so furiously at those working on board that they all started to wave back, and the captain honked the ships booming horn. Every single time we are there, I think of Suresh, and I picture him sailing out on thewaves—as free as he will ever be. Mikkael Sekeres: Welcome back to JCO's Cancer Stories: The Art of Oncology. This ASCO podcast features intimate narratives and perspectives from authors exploring their experiences in oncology. I'm your host, Mikkael Sekeres. I'm Professor of Medicine and Chief of the Division of Hematology at the Sylvester Comprehensive Cancer Center, University of Miami. What a treat we have today. We're joined by Dr. Alexis Drutchas, a Palliative Care Physician and the Director of the Core Communication Program at the Dana-Farber Cancer Institute, and Assistant Professor of Medicine at Harvard Medical School to discuss her article, "The Man at the Bow." Alexis, thank you so much for contributing to Journal of Clinical Oncology and for joining us to discuss your article. Dr. Alexis Drutchas: Thank you. I'm thrilled and excited to be here. Mikkael Sekeres: I wonder if we can start by asking you about yourself. Where are you from, and can you walk us a bit through your career? Dr. Alexis Drutchas: The easiest way to say it would be that I'm from the Detroit area. My dad worked in automotive car parts and so we moved around a lot when I was growing up. I was born in Michigan, then we moved to Japan, then back to Michigan, then to Hong Kong, then back to Michigan. Then I spent my undergrad years in Wisconsin and moved out to Colorado to teach snowboarding before medical school, and then ended up back in Michigan for that, and then on the east coast at Brown for my family medicine training, and then in Boston for work and training. So, I definitely have a more global experience in my background, but also very Midwestern at heart as well. In terms of my professional career trajectory, I trained in family medicine because I really loved taking care of the whole person. I love taking care of kids and adults, and I loved OB, and at the time I felt like it was impossible to choose which one I wanted to pursue the most, and so family medicine was a great fit. And at the core of that, there's just so much advocacy and social justice work, especially in the community health centers where many family medicine residents train. During that time, I got very interested in LGBTQ healthcare and founded the Rhode Island Trans Health Conference, which led me to work as a PCP at Fenway Health in Boston after that. And so I worked there for many years. And then through a course of being a hospitalist at BI during that work, I worked with many patients with serious illness, making decisions about discontinuing dialysis, about pursuing hospice care in the setting of ILD. I also had a significant amount of family illness and started to recognize this underlying interest I had always had in palliative care, but I think was a bit scared to pursue. But those really kind of tipped me over to say I really wanted to access a different level of communication skills and be able to really go into depth with patients in a way I just didn't feel like I had the language for. And so I applied to the Harvard Palliative Care Fellowship and luckily and with so much gratitude got in years ago, and so trained in palliative care and stayed at MGH after that. So my Dana-Farber position is newer for me and I'm very excited about it. Mikkael Sekeres: Sounds like you've had an amazing career already and you're just getting started on it. I grew up in tiny little Rhode Island and, you know, we would joke you have to pack an overnight bag if you travel more than 45 minutes. So, our boundaries were much tighter than yours. What was it like growing up where you're going from the Midwest to Asia, back to the Midwest, you wind up settling on the east coast? You must have an incredible worldly view on how people live and how they view their health. Dr. Alexis Drutchas: I think you just named much of the sides of it. I think I realize now, in looking back, that in many ways it was living two lives, because at the time it was rare from where we lived in the Detroit area in terms of the other kids around us to move overseas. And so it really did feel like that part of me and my family that during the summers we would have home leave tickets and my parents would often turn them in to just travel since we didn't really have a home base to come back to. And so it did give me an incredible global perspective and a sense of all the ways in which people develop community, access healthcare, and live. And then coming back to the Midwest, not to say that it's not cosmopolitan or diverse in its own way, but it was very different, especially in the 80s and 90s to come back to the Midwest. So it did feel like I carried these two lenses in the world, and it's been incredibly meaningful over time to meet other friends and adults and patients who have lived these other lives as well. I think for me those are some of my most connecting friendships and experiences with patients for people who have had a similar experience in living with sort of a duality in their everyday lives with that. Mikkael Sekeres: You know, you write about the main character of your essay, Suresh, who's a barge captain, and you mention in the essay that your family crossed the Atlantic on cargo ships four times when you were growing up. What was that experience like? How much of it do you remember? Dr. Alexis Drutchas: Our house, like our things, crossed the Atlantic four times on barge ships such as his. We didn't, I mean we crossed on airplanes. Mikkael Sekeres: Oh, okay, okay. Dr. Alexis Drutchas: We flew over many times, but every single thing we owned got packed up into containers on large trucks in our house and were brought over to ports to be sent over. So, I'm not sure how they do it now, but at the time that's sort of how we moved, and we would often go live in a hotel or a furnished apartment for the month's wait of all of our house to get there, which felt also like a surreal experience in that, you know, you're in a totally different country and then have these creature comforts of your bedroom back in Metro Detroit. And I remember thinking a lot about who was crossing over with all of that stuff and where was it going, and who else was moving, and that was pretty incredible. And when I met Suresh, just thinking about the fact that at some point our home could have been on his ship was a really fun connection in my mind to make, just given where he always traveled in his work. Mikkael Sekeres: It's really neat. I remember when we moved from the east coast also to the Midwest, I was in Cleveland for 18 years. The very first thing we did was mark which of the boxes had the kids' toys in it, because that of course was the first one we let them close it up and then we let them open it as soon as we arrived. Did your family do something like that as well so that you can, you know, immediately feel an attachment to your stuff when they arrived? Dr. Alexis Drutchas: Yeah, I remember what felt most important to our mom was our bedrooms. I don't remember the toys. I remember sort of our comforters and our pillowcases and things like that, yeah, being opened and it feeling really settling to think, "Okay, you know, we're in a completely different place and country away from most everything we know, but our bedroom is the same." That always felt like a really important point that she made to make home feel like home again in a new place. Mikkael Sekeres: Yeah, yeah. One of the sentences you wrote in your essay really caught my eye. You wrote about when you were younger and say, "I loved those times, the wild abandon of travel, the freedom of being somewhere new, the way identity can shift and expand as experiences grow." It's a lovely sentiment. Do you think those are emotions that we experience only as children, or can they continue through adulthood? And if they can, how do we make that happen, that sense of excitement and experience? Dr. Alexis Drutchas: I think that's such a good question and one I honestly think about a lot. I think that we can access those all the time. There's something about the newness of travel and moving, you know, I have a 3-year-old right now, and so I think many parents would connect to that sense that there is wonderment around being with someone experiencing something for the first time. Even watching my son, Oliver, see a plane take off for the first time felt joyous in a completely new way, that even makes me smile a lot now. But I think what is such a great connection here is when something is new, our eyes are so open to it. You know, we're constantly witnessing and observing and are excited about that. And I think the connection that I've realized is important for me in my work and also in just life in general to hold on to that wonderment is that idea of sort of witnessing or having a writer's eye, many would call it, in that you're keeping your eye open for the small beautiful things. Often with travel, you might be eating ramen. It might not be the first time you're eating it, but you're eating it for the first time in Tokyo, and it's the first time you've had this particular ingredient on it, and then you remember that. But there's something that we're attuned to in those moments, like the difference or the taste, that makes it special and we hold on to it. And I think about that a lot as a writer, but also in patient care and having my son with my wife, it's what are the special small moments to hold on to and allowing them to be new and beautiful, even if they're not as large as moving across the country or flying to Rome or whichever. I think there are ways that that excitement can still be alive if we attune ourselves to some of the more beautiful small moments around us. Mikkael Sekeres: And how do we do that as doctors? We're trained to go into a room and there's almost a formula for how we approach patients. But how do you open your mind in that way to that sense of wonderment and discovery with the person you're sitting across from, and it doesn't necessarily have to be medical? One of the true treats of what we do is we get to meet people from all backgrounds and all walks of life, and we have the opportunity to explore their lives as part of our interaction. Dr. Alexis Drutchas: Yeah, I think that is such a great question. And I would love to hear your thoughts on this too. I think for me in that sentence that you mentioned, sitting at that table with sort of people in the Navy from all over the world, I was that person to them in the room, too. There was some identity there that I brought to the table that was different than just being a kid in school or something like that. To answer your question, I wonder if so much of the challenge is actually allowing ourselves to bring ourselves into the room, because so much of the formula is, you know, we have these white coats on, we have learners, we want to do it right, we want to give excellent care. There's there's so many sort of guards I think that we put up to make sure that we're asking the right questions, we don't want to miss anything, we don't want to say the wrong thing, and all of that is true. And at the same time, I find that when I actually allow myself into the room, that is when it is the most special. And that doesn't mean that there's complete countertransference or it's so permeable that it's not in service of the patient. It just means that I think when we allow bits of our own selves to come in, it really does allow for new connections to form, and then we are able to learn about our patients more, too. With every patient, I think often we're called in for goals of care or symptom management, and of course I prioritize that, but when I can, I usually just try to ask a more open-ended question, like, "Tell me about life before you came to the hospital or before you were diagnosed. What do you love to do? What did you do for work?" Or if it's someone's family member who is ill, I'll ask the kids or family in the room, "Like, what kind of mom was she? You know, what special memory you had?" Just, I get really curious when there's time to really understand the person. And I know that that's not at all new language. Of course, we're always trying to understand the person, but I just often think understanding them is couched within their illness. And I'm often very curious about how we can just get to know them as people, and how humanizing ourselves to them helps humanize them to us, and that back and forth I think is like really lovely and wonderful and allows things to come up that were totally unexpected, and those are usually the special moments that you come home with and want to tell your family about or want to process and think about. What about you? How do you think about that question? Mikkael Sekeres: Well, it's interesting you ask. I like to do projects around the house. I hate to say this out loud because of course one day I'll do something terrible and everyone will remember this podcast, but I fancy myself an amateur electrician and plumber and carpenter and do these sorts of projects. So I go into interactions with patients wanting to learn about their lives and how they live their lives to see what I can pick up on as well, how I can take something out of that interaction and actually use it practically. My father-in-law has this phrase he always says to me when a worker comes to your house, he goes, he says to me, "Remember to steal with your eyes." Right? Watch what they do, learn how they fix something so you can fix it yourself and you don't have to call them next time. So, for me it's kind of fun to hear how people have lived their lives both within their professions, and when I practiced medicine in Cleveland, there were a lot of farmers and factory workers I saw. So I learned a lot about how things are made. But also about how they interact with their families, and I've learned a lot from people I've seen who were just terrific dads and terrific moms or siblings or spouses. And I've tried to take those nuggets away from those interactions. But I think you can only do it if you open yourself up and also allow yourself to see that person's humanity. And I wonder if I can quote you to you again from your essay. There's another part that I just loved, and it's about how you write about how a person's identity changes when they become a patient. You write, "And in that moment the full weight of what he had lost hit me as forcefully as a cresting wave. Not just the physical decline, but the profound shift in identity. What is more, we all live, me included, so precariously at this threshold. In this work, it's impossible not to wonder, what will it be like when it's me? Will I be seen as someone who's lived many lives, or whittled down only to someone who's sick?" Can you talk a little bit more about that? Have you been a patient whose identity has changed without asking you to reveal too much? Or what about your identity as a doctor? Is that something we have to undo a little bit when we walk in the room with the stethoscope or wearing a white coat? Dr. Alexis Drutchas: That was really powerful to hear you read that back to me. So, thank you. Yeah, I think my answer here can't be separated from the illness I faced with my family. And I think this unanimously filters into the way in which I see every patient because I really do think about the patient's dignity and the way medicine generally, not always, really does strip them of that and makes them the patient. Even the way we write about "the patient said this," "the patient said that," "the patient refused." So I generally very much try to have a one-liner like, "Suresh is a X-year-old man who's a barge captain from X, Y, and Z and is a loving father with a," you know, "period. He comes to the hospital with X, Y, and Z." So I always try to do that and humanize patients. I always try to write their name rather than just "patient." I can't separate that out from my experience with my family. My sister six years ago now went into sudden heart failure after having a spontaneous coronary artery dissection, and so immediately within minutes she was in the cath lab at 35 years old, coding three times and came out sort of with an Impella and intubated, and very much, you know, all of a sudden went from my sister who had just been traveling in Mexico to a patient in the CCU. And I remember desperately wanting her team to see who she was, like see the person that we loved, that was fighting for her life, see how much her life meant to us. And that's not to say that they weren't giving her great care, but there was something so important to me in wanting them to see how much we wanted her to live, you know, and who she was. It felt like there's some important core to me there. We brought pictures in, we talked about what she was living for. It felt really important. And I can't separate that out from the way in which I see patients now or I feel in my own way in a certain way what it is to lose yourself, to lose the ability to be a Captain of the ship, to lose the ability to do electric work around the house. So much of our identity is wrapped up in our professions and our craft. And I think for me that has really become forefront in the work of palliative care and in and in the teaching I do and in the writing I do is how to really bring them forefront and not feel like in doing that we're losing our ability to remain objective or solid in our own professional identities as clinicians and physicians. Mikkael Sekeres: Well, I think that's a beautiful place to end here. I can only imagine what an outstanding physician and caregiver you are also based on your writing and how you speak about it. You just genuinely come across as caring about your patients and your family and the people you have interactions with and getting to know them as people. It has been again such a treat to have Dr. Alexis Drutchas here. She is Director of the Core Communication Program at Dana-Farber Cancer Institute and Assistant Professor of Medicine at Harvard Medical School to discuss her article, "The Man at the Bow." Alexis, thank you so much for joining us. Dr. Alexis Drutchas: Thank you. This has been a real joy. Mikkael Sekeres: If you've enjoyed this episode, consider sharing it with a friend or colleague, or leave us a review. Your feedback and support helps us continue to save these important conversations. If you're looking for more episodes and context, follow our show on Apple, Spotify, or wherever you listen, and explore more from ASCO at ASCO.org/podcasts. Until next time, this has been Mikkael Sekeres for the ASCO podcast Cancer Stories: The Art of Oncology. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Show notes: Like, share and subscribe so you never miss an episode and leave a rating or review. Guest Bio: Dr. Alexis Drutchas is a palliative care physician at Dana Farber Cancer Institute.

In this 320th episdode I welcome Drs. Essandoh and Cody back to the show to discuss the latest data and guidelines around the use of the Impella device and how it compares to IABP and ECMO.Our Sponsors:* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com* Check out Factor and use my code accrac50off for a great deal: https://www.factor75.com* Check out Truelearn: https://tinyurl.com/ACCRACTL* Check out Uncommon Goods: https://uncommongoods.com/ACCRACAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

On this episode of JHLT: The Podcast, the Digital Media Editors invite co-lead author Nir Uriel, MD, Director of Advanced Heart Failure and Cardiac Transplantation at New York Presbyterian Hospital and Professor of Medicine at Columbia University. Dr. Uriel joins to discuss the work of the Cardiogenic Shock Working Group (CSWG) and their recent paper, “Outcomes of patients supported on Impella 5.5 for more than 14 days: A Cardiogenic Shock Working Group registry analysis.” The discussion explores: Why patients on longer duration of MCS had better survival but maintained similar rates of serious adverse events (SAEs) Why the study might show fewer SAEs than the literature historically shows How temporary MCS devices are selected in clinical settings in patients with cardiogenic shock The ongoing and upcoming activities of CSWG For the latest studies from JHLT, visit www.jhltonline.org/current, or, if you're an ISHLT member, access your Journal membership at www.ishlt.org/jhlt. Don't already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.org.

The JEMS Report: ROSC and Roll   Cardiovascular perfusionist Brian Kress joins Mike Brown to dissect a high-stakes cardiac arrest case that underscores the critical moments following return of spontaneous circulation (ROSC). They walk through the fragile physiology of post-arrest patients and reveal how early, expert support in the field and hospital dramatically influences outcomes. From the importance of bystander CPR and prehospital interventions to advanced cardiac catheterization and mechanical circulatory support using the Impella device, Brian explains the science behind left ventricular end diastolic pressure (LV EDP) and how offloading the heart aids recovery. This conversation deep dives into the often-overlooked complexities of managing post-ROSC states, emphasizing the need for vigilant hemodynamic monitoring and judicious use of vasopressors. A must-listen for EMS, perfusionists and critical care providers seeking a nuanced understanding of cardiac arrest survival pathways beyond the initial resuscitation.

In dieser Folge geht es um lebensrettenden Maschinenbau im Miniaturformat. Sarah und Marco begrüßen den Gewinner des diesjährigen Aachener Ingenieurpreises, Dr. Thorsten Sieß vom Aachener Unternehmen Abiomed, der für seine Entwicklung der kleinsten Herzpumpe der Welt ausgezeichnet wird, und sprechen mit ihm über den Weg zu seiner lebensrettenden Innovation.

One unstable patient, three departments, and every nurse on alert... Let's break down what really happens during a high-risk STEMI. This episode follows the case of a 62-year old patient from ER to the Cath Lab to the ICU. Nurses Sarah Vance and Caitlyn Nichols help us explore the role of nurses in each stage of care, from stabilizing the patient to placing an Impella device.We cover everything from IV placement and medications to monitoring patients through each phase of care. Learn how to prepare patients for the Cath Lab, manage complications like V-fib and bleeding post-PCI, and support the next team during handoffs. This is a must-listen for nurses involved in cardiac care!Topics discussed in this episode:Case presentation of a 62-year old patientER nurse priorities for STEMI patientsInitial treatment and stabilizationWhy “M.O.N.A.” is an outdated practicePreparing the patient for the Cath Lab teamCath Lab nurse responsibilities and role during PCIHigh-risk PCI vs. standard PCIManaging common complicationsTransitioning from Cath Lab to ICUICU nurse priorities for post-PCI patientsImpella placement and monitoringManaging reperfusion arrhythmiasLong-term care and getting patients off the ImpellaPatient and family educationConnect with Sarah Vance:https://www.instagram.com/iseeu_nurse/Connect with Caitlyn Nichols:https://www.instagram.com/icunursingnotesbycaitlyn/Mentioned in this episode:CONNECT

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning speaks with Dr. Daniel Goldstein, professor and vice chairman of Montefiore Health System in New York, USA, about the importance of mentorship. Chapters 00:00 Intro 03:24 JANS 1, Cardiac 05:42 JANS 2, General 08:40 JANS 3, Cardiac 12:17 JANS 4, General 13:45 JANS 5, Cardiac 14:53 Video 1, Cardiac 16:48 Video 2, Thoracic 18:53 Video 3, Cardiac 20:29 Dr. Goldstein Interview 33:06 Closing They explore how to be an effective mentor, outlining essential steps in mentoring and the process of developing great surgeons. They also discuss the significance of volunteering and contributing to advance within the field. Additionally, they cover the incentives of being a good mentor, provide advice for trainees currently seeing to join a program, and delve into how and why Dr. Goldstein was selected by the ISHLT Foundation to receive the 2025 Francis D. Pagani, MD, Endowed Mentorship Award. In a separate segment, Joel addresses minimally invasive surgery in Europe.   Joel also highlights recent JANS articles on lifetime management of heart valve disease, social media use among cardiothoracic surgeons, a surgeon's tool kit for mitral valve-induced left ventricular outflow tract obstruction with minimal septal hypertrophy, transatlantic analysis of gender representation in general thoracic surgery, and extent of coronary artery disease and clinical outcomes with ticagrelor monotherapy vs aspirin after coronary artery bypass grafting.  In addition, Joel explores an infarct exclusion technique for posterior ischemic ventricular septal defect in a patient with Impella 5.5 support, mastering robotic lung resection using the French lobectomy technique for standardized surgical education, and assessment, debridement, and annular support for valve replacement in a case of mitral annular calcification. Before closing, Joel highlights upcoming events in CT surgery.    JANS Items Mentioned  1.) Lifetime Management of Heart Valve Disease—Treat It Early and Treat It Right, First Time  2.) Social Media Use Among Cardiothoracic Surgeons: The Online Landscape and Comparisons Between Subgroups  3.) A Surgeon's Toolkit for Mitral Valve-Induced Left Ventricular Outflow Tract Obstruction With Minimal Septal Hypertrophy  4.) Trans-Atlantic Analysis of Gender Representation in General Thoracic Surgery: Challenges Permeate the Academic Community  5.) Extent of Coronary Artery Disease and Clinical Outcomes With Ticagrelor Monotherapy Versus Aspirin After Coronary Artery Bypass Grafting: Insights From the TiCAB Trial  CTSNET Content Mentioned  1.) Infarct Exclusion Technique for Posterior Ischemic Ventricular Septal Defect in a Patient With Impella 5.5 Support  2.) Mastering Robotic Lung Resection: The French Lobectomy Technique for Standardized Surgical Education  3.) Mitral Annular Calcification: Assessment, Debridement, and Annular Support for Valve Replacement  Other Items Mentioned  1.) Cardiac Surgical Arrest—An International Conversation, Part 3  2.) Career Center   3.) CTSNet Events Calendar  Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

New Insights from the DanGer Shock Trial!

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning speaks with Dr. David Kalfa, the incoming Chief of Pediatric Cardiac Surgery and Co-Director of the Heart Institute at Nicklaus Children's Hospital in Miami, about allogeneic mitral valve transplants. Chapters 00:00 Intro 01:46 Interview Preview 02:54 MV Surgery After Failed Intervention 07:46 Tears Predict Outcomes After Hemi-Arch 10:32 Pain Catastrophizing Scale 14:27 ARR w Stentless Biopros, Sex Difference 16:38 Open Implant TAV via Redo Sternotomy 19:05 Repeat Sternotomy w Completion Unifocaliz 21:07 Direct Aortic Impella 5.5 in PC Shock 25:16 Dr. Kalfa Interview, AMV Transplant 39:58 Upcoming Events 41:26 Closing They discuss methods for obtaining a mitral valve for transplantation, and topics such as immunosuppression, aortic coagulation, and the progress that has been made in this field. They also explore how to perform a living allogeneic heart valve transplant and the future of this technique.   Joel also highlights recent JANS articles on mitral valve surgery after failed transcatheter intervention for mitral regurgitation, whether distal anastomotic new entry tears predict long-term outcomes after hemiarch repair for DeBakey I aortic dissection, using a pain catastrophizing scale as a predictor for acute postoperative pain following video-assisted thoracoscopic surgery lobectomy, and sex difference in aortic root replacement with a stentless bioprosthesis.  In addition, Joel explores an open implantation of a transcatheter aortic valve via redo sternotomy, mitral valve replacement, and tricuspid valve repair in a high-risk patient, repeat sternotomy with completion unifocalization and extensive pulmonary arterial reconstruction in ToF/PA/MAPCAs, and direct aortic Impella 5.5 in post-cardiotomy shock. Before closing, Joel highlights upcoming events in CT surgery.    JANS Items Mentioned  1.) Mitral Valve Surgery After Failed Transcatheter Intervention for Mitral Regurgitation: Techniques, Challenges, and Outcomes  2.) Distal Anastomotic New Entry Tears Predict Long-Term Outcomes After Hemi-Arch Repair for DeBakey I Aortic Dissection  3.) Pain Catastrophizing Scale as a Predictor for Acute Postoperative Pain Following Video-Assisted Thoracoscopic Surgery Lobectomy  4.) Sex Difference in Aortic Root Replacement With a Stentless Bioprosthesis  CTSNET Content Mentioned  1.) Open Implantation of a Transcatheter Aortic Valve via Redo Sternotomy, Mitral Valve Replacement, and Tricuspid Valve Repair in a High-Risk-Patient  2.) Challenging Pulmonary Arterial Reconstruction: Repeat Sternotomy With Completion Unifocalization and Extensive Pulmonary Arterial Reconstruction in ToF/PA/MAPCAs   3.) Direct Aortic Impella 5.5 in Post-Cardiotomy Shock  Other Items Mentioned  1.) Allogeneic Mitral Valve Transplant: Historical Precedent, Current Considerations, and Future Implementation  2.) Cardiac Surgical Arrest—An International Conversation, Part 1  3.) Winners of the 2025 CTSNet Instructional Video Competition  4.) Career Center   5.) CTSNet Events Calendar  Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

In this debut episode of JACC This Week with Editor-in-Chief Dr. Harlan Krumholz, we explore groundbreaking studies and timely insights from the July 1st issue. Highlights include the impact of wildfire smoke on heart failure risk, new hemodynamic data on mechanical circulatory support in cardiogenic shock, and sobering cardiovascular mortality trends over the past 25 years. Plus, updates on aspirin use, cognitive impairment in CVD, ACC/AHA performance measures, and a leadership reflection from ACC President Dr. Christopher Kramer.

Integrating POCUS into transport protocols can revolutionize patient care and outcome in criticalcare scenarios. Today, host Shane Turner sits down with flight paramedic Isaac Bennett toexplore the critical role of point-of-care ultrasound (POCUS) in the management of Impellasupported patients during transport. With 14 years of EMS experience, including 7 years flying with the Hospital Wing program based in Memphis, Isaac shares his expert insights on howPOCUS can guide Impella positioning, monitor volume status, and troubleshoot alarms effectively, even in challenging pre-hospital environments.Plus, they discuss practical techniques for obtaining clear cardiac views and the importance oflandmarks and regular practice. This episode is a must-listen for transport clinicians looking to enhance their diagnostic capabilities and improve patient outcomes with POCUS.In this episode:Shane Turner, RN, CFRN, NRP, FP-C, CMTE, Chattanooga, TN, AbiomedIsaac Bennett, Flight Paramedic, Memphis Tennessee

In this second installment of our Data Deep Dive, Shane Turner reconnects with Ken Kasica, who specializes in cardiovascular pharmacology at Abiomed. The two dissect the complex interactions between drug therapies and the Impella heart pumps in critical care. Learn about the impact of vasoconstrictive drugs such as levosimendan and norepinephrine on Impella performance, and studies that highlight the risks associated with high doses of inotropes and vasopressors. This episode provides essential insights for transport clinicians on managing patients with these medications, including strategies from heart teams at destination centers for device escalation, and the latest advancements in the field.In this episode:Shane Turner, RN, CFRN, NRP, FP-C, CMTE, Chattanooga, TN, AbiomedKen Kasica, PharmD, MBA, Director, Scientific Intelligence, Abiomed

Teaching best practices for transporting Impella patients is something Zac Bunzey handles every day. As a clinical education manager at Life Flight Network, Zac joins Shane Turner to share how targeted training campaigns, hands-on experience, and tools like the Impella app, combined with Abiomed's 24/7 support, have markedly boosted crew confidence and proficiency.Plus, you'll learn about the importance of cognitive aids and routine practice with low-frequency events to maintain skills. Whether you're experienced in Impella transports or new to the process, this episode offers crucial strategies to enhance your crew's readiness and effectiveness in managing these critical patients.In this episode:Shane Turner, RN, CFRN, NRP, FP-C, CMTE, Chattanooga, TNZac Bunzey, Clinical Education Manager, Life Flight Network

Are you equipped to handle cardiogenic shock? In this episode, you'll gain insights from an expert on the frontlines about the complexities of caring for these critical patients and how you can excel in providing world-class critical care transport.Shane Turner sits down with Dr. Adam Gottula, an emergency physician and critical care intensivist from Methodist Hospital in San Antonio, Texas. They discuss the management of cardiogenic shock in transport settings, the crucial role of a multidisciplinary approach, and the latest strategies for improving patient outcomes.Dr. Gottula shares the importance of cognitive checklists, standardized patient classification, and the life-saving role of the Impella device during transport. Plus, essential practices for optimizing outcomes in patients with Impella support during cardiac arrest, including the critical steps of prompt CPR and correct device positioning.Shane Turner, RN, CFRN, NRP, FP-C, CMTE, Chattanooga, TNAdam Gottula, M.D., San Antonio, Texas

In this episode, Dr. Valentin Fuster dives into the complex and high-stakes world of cardiogenic shock, spotlighting new clinical trials, expert consensus guidance, and cutting-edge insights from machine learning. From evaluating the impact of intra-aortic balloon pumps to rethinking mechanical support strategies, the episode delivers a powerful update on one of cardiology's most urgent challenges.

In today's episode of the Legal Nurse Podcast, we delve into the life-saving world of cardiac stents with expert cardiologist Joshua Willis. Discover the evolution of stents, from their inception to their transformative role in treating heart disease. Joshua shares insights into the critical procedures that follow stent insertion and navigates the complexities of balancing patient care with available resources. You'll discover how these medical advancements have changed lives and the collaborative decision-making involved in this vital field. Tune in and explore the fascinating journey of cardiac care! Heart Procedures: Cardiac Stents and Beyond Addresses these Questions: Join us for this episode, during which we discuss these questions. How did the concept of cardiac stents develop, and who was a key figure in their development? What are the differences between bare metal stents and drug-eluting stents, and how do they function in preventing coronary artery blockages? What are the typical medications used post-stent insertion to prevent clot formation, and why are they crucial? How does the radial approach differ from the femoral approach in cardiac procedures, and why has it become more favored? What role does shared governance play in deciding between stent insertion and coronary artery bypass surgery for a patient? Listen to our podcasts or watch them using our app, Expert.edu, available at legalnursebusiness.com/expertedu. Get the free transcripts and also learn about other ways to subscribe. Go to Legal Nurse Podcasts subscribe options by using this short link: http://LNC.tips/subscribepodcast. Are you finding it tough to Grow Your LNC Business? You are not alone! Join us for the 12th LNC SUCCESS® 3-DAY ONLINE CONFERENCE on November 13, 14, & 15, 2025! It's a chance to learn how to overcome common challenges and gain the skills you need to succeed in legal nurse consulting. Connect with industry experts who will share practical strategies for standing out, building strong relationships with attorneys, and effectively presenting your value. No matter your experience level, this conference will empower you to discover fresh opportunities and advance your business. What to Expect Expert-Led Sessions: Engage with sessions led by top industry professionals. Interactive Workshops: Participate in hands-on workshops designed to enhance your consulting skills. Networking Opportunities: Build lasting connections with peers and potential clients. Resource Materials: Receive exclusive materials that will support your ongoing professional development. Don't miss this chance to make a real impact on your business. Register Today Secure your spot at the 12th LNC SUCCESS® 3-DAY ONLINE CONFERENCE on November 13, 14, & 15, 2025, and take your first step toward becoming a leading legal nurse consultant! We look forward to welcoming you to this pivotal event in February 2025! Your Presenter for Heart Procedures: Cardiac Stents and Beyond Joshua M Willis, MD Dr. Willis completed a cardiology fellowship at the Cleveland Clinic Foundation (2007-2010) and an Interventional Cardiology fellowship at the University of Florida (2010-2011).       In 2011, he took a private cardiology practice job in Chattanooga, Tennessee, splitting his time between hospital-based procedures (cardiac catheterizations, percutaneous coronary interventions, Swan Ganz catheterization for invasive hemodynamic measurements, Impella device placement etc.) and clinic duties, and seeing approximately 24-26 patients per full clinic day. His job responsibilities at Wellstar include three days in the hospital, providing Interventional and General Cardiology coverage and 1.5 days in clinic seeing outpatients, total of 35-40 outpatient visits per week. Connect with Joshua M Willis, MD by email at cardioexpertwitness@gmail.com,

Today we're going ‘back to basics' with Austin Provence, a cardiothoracic nurse who brings a decade of experience in transporting patients with Impella devices and the importance of seamless teamwork. With over a decade of experience, Austin highlights two critical scenarios: stable patients needing higher care and critically ill patients requiring immediate interventions. He underscores the importance of mastering proper Impella placement and management, noting that a significant portion of these patients may present additional health challenges.Austin shares practical tips on maintaining the correct angle to prevent bleeding, managing sedation, and ensuring clear communication between hospital and transport teams. This episode is packed with best practices and strategies to enhance the competency and confidence of transport clinicians in handling complex cardiac cases.In this episode:Shane Turner, RN, CFRN, NRP, FP-C, CMTE, Chattanooga, TNAustin Provence, Hospital Wing Flight Nurse

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.

Cardiogenic shock is a devastating condition with a persistent 50% mortality rate. However, groundbreaking treatments and technologies are now dramatically improving survival odds. Join Shane Turner as he sits down with Jason Weatherly, Cardiogenic Shock Commercial Marketing Manager at Abiomed, to explore these advancements and the life-saving impact of the Impella device.Jason highlights the recent DanGer Shock RCT, which confirmed that Impella CP® with SmartAssist® improves survival by 12.7%. Together, they delve into how these medical breakthroughs are crucially linked to critical care transport, emphasizing innovative strategies that are essential for enhancing patient outcomes and shaping the future of cardiogenic shock treatment.In this episode:Shane Turner, RN, CFRN, NRP, FP-C, CMTE, Chattanooga, TNJason Weatherly, Cardiogenic Shock Commercial Marketing Manager at Abiomed

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning speaks with Dr. Husam Balkhy, Professor of Surgery and the Director of Robotic and Minimally Invasive Cardiac Surgery at University of Chicago Medicine and President of The International Society for Minimally Invasive Cardiothoracic Surgery (ISMICS), about robotic totally endoscopic cardiac surgery procedures. They discuss potential ways to get the world to perform more robot-assisted surgeries, the building blocks to learning robotics, the future of learning robotics, and what to expect this year at the ISMICS 2025 Annual Meeting. They also explore Dr. Balkhy's new President's Series on CTSNet and provide insights into the first video of this series. Joel also highlights some of the videos in the CTSNet Resident Video Competition and the robotics vs VATS debate in Britain.   Joel also reviews recent JANS articles on the impact of restricted chests on long-term lung function parameters following lung transplantation in patients with interstitial lung disease, determinants of inadequate cardioprotection in adult patients with left ventricular dysfunction, engineered heart muscle allografts for heart repair in primates and humans, and risk factor analysis for 30-day mortality after surgery for infective endocarditis.  In addition, Joel explores open repair of descending thoracic and thoracoabdominal aortic aneurysms, totally 3D endoscopic third tricuspid valve replacement, and how to use the Impella for on-pump CABG in patients with low EF. Before closing, he highlights upcoming events in CT surgery.   JANS Items Mentioned  1.) The Impact of Restricted Chests on Long-Term Lung Function Parameters Following Lung Transplantation in Patients With Interstitial Lung Disease    2.) Determinants of Inadequate Cardioprotection in Adult Patients With Left Ventricular Dysfunction  3.) Engineered Heart Muscle Allografts for Heart Repair in Primates and Humans  4.) Risk Factor Analysis for 30-Day Mortality After Surgery for Infective Endocarditis   CTSNET Content Mentioned  1.) Open Repair of Descending Thoracic and Thoracoabdominal Aortic Aneurysms  2.) Totally 3D Endoscopic Third Tricuspid Valve Replacement  3.) ICC 2024 | How I Use the Impella for On-Pump CABG in Patients With Low EF: Insertion, Intraoperative Management, and Weaning/Removal  Other Items Mentioned  1.) President's Series With Husam Balkhy | ISMICS President   2.) ISMICS 2025 Annual Meeting   3.) Career Center   4.) CTSNet Events Calendar  Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

This is part two of a two part program covering some of the most listened to pieces we've done in the last 12 months. We'd love you to check out part 1, which is here: https://topmedtalk.libsyn.com/annual-digest-part-1-topmedtalk In this piece we cover and reflect upon the following podcasts: "The evolution of the Impella device in anesthesia, critical care, and perioperative medicine” https://topmedtalk.libsyn.com/the-evolution-of-the-impella-device-in-anesthesia-critical-care-and-perioperative-medicine-anes24 Is Trauma Informed Care part of your perioperative process? https://topmedtalk.libsyn.com/is-trauma-informed-care-part-of-your-perioperative-process-topmedtalk ROCKet Trial and PANDOS | Euroanaesthesia 2024 https://topmedtalk.libsyn.com/rocket-trial-and-pandos-tmt-at-ea24 "Patient Safety and Quality: New Standards in Anesthesia | #ANES24" https://topmedtalk.libsyn.com/patient-safety-and-quality-new-standards-in-anesthesia-anes24 And “Perioperative medicine in focus | EBPOM 24” https://topmedtalk.libsyn.com/perioperative-medicine-in-focus-ebpom-24

How does continuous learning and practical experience on the front lines make a difference in transport? Today's episode is hosted by critical care transport trainer, Jena Billig, who sits down with Josh Klute, an expert flight and ICU nurse, who credits specialized Impella training with his confidence and success in transport. Josh recounts his initial challenges and lack of confidence during his first Impella transport, contrasting it with the marked improvement in his skills and confidence after receiving targeted training. Jena and Josh discuss the necessity of continuous education and the value of tailored training in empowering transport teams, ultimately enhancing patient care and provider confidence.In this episode:Jena Billig, BSN, RN, CCRN, CFRN, Idaho Springs, ColoradoJosh Klute, EMT, Colorado Springs, Colorado

In this podcast, Dr. Valentin Fuster discusses a study on the use of the microaxial flow pump (Impella) in treating older patients with cardiogenic shock following a myocardial infarction. The findings suggest that while the Impella pump can reduce mortality in younger patients, its effectiveness diminishes in those over 77, highlighting the need for age-based patient selection to optimize outcomes in this complex condition.

Impella devices can be game-changers for cardiogenic shock, and members of the care team who manage these patients during transport require specific training and skills to optimize patient outcomes. Today, host Shane Turner is joined by Ryan Harmon to take an inside look at the systematic approach one clinician uses to troubleshoot issues and optimize these advanced therapies. Ryan Harmon is a clinical care coordinator in the emergency room with extensive experience as both a nurse and a paramedic.Harmon emphasizes the need for a systematic approach to troubleshooting issues, such as preload, afterload, and positioning, and the importance of managing medications to avoid complications. You'll also learn the value of having a knowledgeable partner and being prepared for potential challenges during transports.In this episode:Shane Turner, RN, CFRN, NRP, FP-C, CMTE, Chattanooga, TNRyan Harmon, Critical Care Transport Nurse/Paramedic, Lebanon, OH

Dr. Trina Augustin, assistant professor of both anesthesiology and perioperative medicine as well as emergency medicine takes us on a deep dive into the care of persons with aortic stenosis. In this chapter, Alex and Venk learn about how to use ultrasound to diagnose AS, the keys to resuscitation, the pathophysiology of this condition, as well as the value of consultative services and the potential interventions that they may unlock for these patients. Kickoff season 4 with this in depth reminder that sometimes the heart has many hidden perils beyond ACS.  CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch; @KatrinaJoyAugustin Email - AlwaysOnEM@gmail.com REFERENCES & LINKS Lichtenstein DA, Meziere GA. Relevance of Lung Ultrasound in the Diagnosis of Acute Respiratory Failure. Chest 2008; 134:117-125 Walsh MH, Smyth LM, Desy JR, Fischer EA, Goffi A, Li N, Lee M, St-Pierre J, Ma IWY. Lung Ultrasound: A Comparison of image interpretation accuracy between curvillinear and phased array transducers. Australia J Ultrasound Med, 26:150-156 Alzahrani H, Woo MY, Johnson C, Pageau P, Millington S, Thiruganasambandamoorthy V. Can severe aortic stenosis be identified by emergency physicians when interpreting a simplified two-view echocardiogram obtained by trained echocardiographers? Crit Ultrasound J. 2015 Apr 18;7:5. doi: 10.1186/s13089-015-0022-8. PMID: 25932319; PMCID: PMC4409610. Furukawa A, Abe Y, Morizane A, Miyaji T, Hosogi S, Ito H. Simple echocardiographic scoring in screening aortic stenosis with focused cardiac ultrasonography in the emergency department. J Cardiol. 2021 Jun;77(6):613-619. doi: 10.1016/j.jjcc.2020.12.006. Epub 2020 Dec 29. PMID: 33386216. Lin J, Drapkin J, Likourezos A, Giakoumatos E, Schachter M, Sarkis JP, Moskovits M, Haines L, Dickman E. Emergency physician bedside echocardiographic identification of left ventricular diastolic dysfunction. American Journal of Emergency medicine  Ehrman RR, Russell FM, Ansari AH, Margeta B, Clary JM, Christian E, Cosby KS, Bailitz J. Can emergency physicians diagnose and correctly classify diastolic dysfunction using bedside echocardiography? Am J Emerg Med. 2015 Sep;33(9):1178-83. doi: 10.1016/j.ajem.2015.05.013. Epub 2015 May 21. PMID: 26058890.2021;44:20-25 Del Rios M, Colla J, Kotini-Shah P, Briller J, Gerber B, Prendergast H. Emergency physician use of tissue Doppler bedside echocardiography in detecting diastolic dysfunction: an exploratory study. Crit Ultrasound J. 2018 Jan 25;10(1):4. doi: 10.1186/s13089-018-0084-5. PMID: 29372430; PMCID: PMC5785451. Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, de Waha A, Richardt G, Hennersdorf M, Empen K, Fuernau G, Desch S, Eitel I, Hambrecht R, Lauer B, Böhm M, Ebelt H, Schneider S, Werdan K, Schuler G; Intraaortic Balloon Pump in cardiogenic shock II (IABP-SHOCK II) trial investigators. Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. Lancet. 2013 Nov 16;382(9905):1638-45. doi: 10.1016/S0140-6736(13)61783-3. Epub 2013 Sep 3. PMID: 24011548. Aksoy O, Yousefzai R, Singh D, Agarwal S, O'Brien B, Griffin BP, Kapadia SR, Tuzcu ME, Penn MS, Nissen SE, Menon V. Cardiogenic shock in the setting of severe aortic stenosis: role of intra-aortic balloon pump support. Heart. 2011 May;97(10):838-43. doi: 10.1136/hrt.2010.206367. Epub 2010 Oct 20. PMID: 20962337. Karatolios K, Chatzis G, Luesebrink U, Markus B, Ahrens H, Tousoulis D, Schieffer B. Impella support following emergency percutaneous balloon aortic valvuloplasty in patients with severe aortic valve stenosis and cardiogenic shock. Hellenic J Cardiol. 2019 May-Jun;60(3):178-181. doi: 10.1016/j.hjc.2018.02.008. Epub 2018 Mar 21. PMID: 29571667. Gottlieb M, Long B, Koyfman A. Evaluation and Management of Aortic Stenosis for the Emergency Clinician: An Evidence-Based Review of the Literature. J Emerg Med. 2018 Jul;55(1):34-41. doi: 10.1016/j.jemermed.2018.01.026. Epub 2018 Mar 7. PMID: 29525246.  

CardioNerds (Dr. Yoav Karpenshif – Chair of the CardioNerds Critical Care Cardiology Council) join Dr. Munim Khan, Dr. Shravani Gangidi, and Dr. Rachel Goodman from Tufts Medical Center's general cardiology fellowship program for hot pot in China Town in Boston. They discuss a case involving a patient who presented with stress cardiomyopathy leading to cardiogenic shock. Expert commentary is provided by Dr. Michael Faulx from the Cleveland Clinic. Notes were drafted by Dr. Rachel Goodman. A young woman presents with de novo heart-failure cardiogenic shock requiring temporary mechanical circulatory support who is found to have basal variant takotsubo cardiomyopathy.  We review the definition and natural history of takotsubo cardiomyopathy, discuss initial evaluation and echocardiographic findings, and review theories regarding pathophysiology of the clinical syndrome. We also highlight complications of takotsubo cardiomyopathy, with a focus on left ventricular outflow obstruction, cardiogenic shock, and arrythmias. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls Takotsubo cardiomyopathy is defined as a reversible systolic dysfunction with wall motion abnormalities that do not follow a coronary vascular distribution. Takotsubo cardiomyopathy is a diagnosis of exclusion; patients often undergo coronary angiography to rule out epicardial coronary artery disease given an overlap in presentation and symptoms with acute myocardial infarction. There are multiple echocardiographic variants of takotsubo. Apical ballooning is the classic finding, but mid-ventricular, basal, and biventricular variants exist as well. Patients with takotsubo cardiomyopathy generally recover, but there are important complications to be aware of.  These include arrhythmia, left ventricular outflow tract (LVOT) obstruction related to a hyperdynamic base in the context of apical ballooning, and cardiogenic shock. Patients with Impella devices are at risk of clot formation and stroke. Assessing the motor current can be a clue to what is happening at the level of the motor or screw. Notes What is Takotsubo Syndrome (TTS)? TTS is a syndrome characterized by acute heart failure without epicardial CAD with regional wall motion abnormalities seen on echocardiography that do not correspond to a coronary artery territory (see below).1 TTS classically develops following an acute stressor—this can be an emotional or physical stressor.1 An important feature of TTS is that the systolic dysfunction is reversible.  The time frame of reversibility is variable, though generally hours to weeks.2 Epidemiologically, TTS has a predilection for post-menopausal women, however anyone can develop this syndrome.1 TTS is a diagnosis of exclusion. Coronary artery disease (acute coronary syndrome, spontaneous coronary artery dissection, coronary embolus, etc) should be excluded when considering TTS. Myocarditis is on the differential diagnosis. What are the echocardiographic findings of takotsubo cardiomyopathy? The classic echocardiographic findings of TTS is “apical ballooning,” which is a way of descripting basal hyperkinesis with mid- and apical hypokinesis, akinesis, or dyskinesis.3 There are multiple variants of TTS. The four most common are listed below:3(1) Apical ballooning (classic TTS)(2) Mid-ventricular variant(3) Basal variant (4) Focal variant Less common variants include the biventricular variant and the isolated right ventricular  variant.3 Do patients with TTS generally have EKG changes or biomarker elevation? Patients often have elevated troponin, though the severity wall motion abnormalities seen on TTE i...

The Australian ERAS+ Conference and 2024 World Congress of Prehabilitation and Perioperative Medicine is an essential event for practitioners around the world. TopMedTalk were there and we will be bringing you a series of interviews with some of the key players and speakers. This piece is presented by Kate Leslie and Mike Grocott with their guest, David Watters, Alfred Deakin Professor of Surgery at Deakin University in Geelong, Victoria, Australia, based at the University Hospital Geelong, he is also Director of Surgery at Safer Care Victoria. -- TopMedTalk has ramped up its release schedule recently in response to growing demand for our recent conference coverage. Expect to see releases more frequently over the next few months. Ensure you are subscribed to us, so you don't miss out, and while you're here why not check out some of our new recent releases: ASA Presidents pass the baton | #ANES24 https://topmedtalk.libsyn.com/asa-presidents-pass-the-baton-anes24 The evolution of the Impella device in anesthesia, critical care, and perioperative medicine | #ANES24 https://topmedtalk.libsyn.com/the-evolution-of-the-impella-device-in-anesthesia-critical-care-and-perioperative-medicine-anes24    

The American Society of Anesthesiologists (ASA)'s annual general meeting; Anesthesiology 2024. Exclusive cutting edge conversations recorded at the conference with some of the key speakers, guests and delegates. The discussion highlights the growing use of the Impella device in anesthesia and critical care, particularly for high-risk patients with severe heart failure or cardiogenic shock. Presented by Desiree Chappell, Monty Mythen and Mike Grocott with their guest Asad Usman, Anesthesiologist, critical care specialist and physician with Penn Medicine, Pennsylvania.

On this week's listener series episode, Jess shares the birth story of her daughter, the second of her four children. Jess' birth was mostly uncomplicated until immediately following her delivery via csection when breathing became difficult and her heart rate skyrocketed. Jess' heart was failing and her doctors scrambled to keep her alive. Through the use of ECMO and Impella, along with many other interventions and procedures Jess' life was saved. She shares more about what lead to her heart failure and subsequent cardiac arrest along with her two subsequent pregnancies/births in this episode.  On this episode, you will hear:- Retrograde amnesia- High blood pressure in pregnancy- Cardiac arrest and the use of Impella and ECMO- Discovering a tumor and surgery following- Subsequent c-sections and healing processIf you have a birth trauma story you would like to share with us, click this link and fill out the form. For more birth trauma content and a community full of love and support, head to my Instagram at @thebirthtrauma_mama.Learn more about the support and services I offer through The Birth Trauma Mama Therapy & Support Services.

Are there different training protocols for maintaining expertise in Impella patient management when cases are infrequent? In this episode, Shane Turner is joined by Dustin McKeel, a seasoned Flight Paramedic and Clinical Base Educator from Memphis, to explore how the city's limited critical care options have spurred innovative training solutions.Learn how hands-on cadaver labs, real case studies, and rigorous simulations are equipping transport crews with the confidence and skills needed to handle complex patient scenarios effectively. Don't miss this insightful discussion on enhancing clinical capabilities and decision-making skills through advanced training methods.In this episode:Shane Turner, RN, CFRN, NRP, FP-C, CMTE, Chattanooga, TNDustin McKeel, FP-C, Flight Paramedic, Clinical Base Educator, Memphis, TN

This piece looks at the DanGer Shock Trial which examines the efficacy of the Impella device in reducing mortality in patients with acute myocardial infarction and cardiogenic shock. We explain how the device works, its implantation process, and the significant findings from the trial, including a notable reduction in six-month mortality with a number needed to treat (NNT) of eight. Despite higher rates of bleeding and renal filtration therapy in the Impella group, the trial provides strong evidence supporting its use in high-volume centers with trained personnel, emphasizing the importance of careful patient selection and timely intervention. Presented by Andy Cumpstey and Joff Lacey with their guest Vasileios Panneudales, an interventional cardiologist at Brompton and Harefield Hospitals.

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Show notes at pharmacyjoe.com/episode931. In this episode, I'll discuss an alternative to a dextrose-based purge solution for patients with an Impella ventricular assist device that also need a PET scan. The post 931: Non-dextrose purge solution for patients with an Impella that require a PET scan appeared first on Pharmacy Joe.

Keeping Impella access sites exposed during movement and transport can make a critical difference in patient care, especially during short ground transports. In this episode, former flight nurse D.D. Finder sits down with trainer Jena Billig to recount a challenging case involving a heart failure patient on an Impella device for ECMO treatment. In this episode:Jena Billig, BSN, RN, CCRN, CFRN, Idaho Springs, ColoradoD.D. Finder, RN, BSN, CCRN, CFRN, Colorado

Welcome to Abiomed's Quarterly Update, where education is at the forefront. In this episode, host Shane Turner is joined by Jena Billig, primary trainer for the West region, to dive into the intricacies of the Impella pump's heparin-free purge system.Jena provides a comprehensive understanding while addressing misconceptions. She explains the importance of using a dextrose and water-based purge solution with heparin or sodium bicarb additive to prevent blood proteins from accumulating in the pump motor housing. Plus, Shane and Jena explore new features of the Impella Five, gen two catheter, designed to enhance safety for transport providers, including the intuitive catalog system and three-point fixation method.Whether you're a seasoned provider or new to the field, this episode offers valuable insights to improve patient care and transport practices. Tune in now to stay informed and elevate your knowledge of the Impella device and purge system!In this episode:Shane Turner, RN, CFRN, NRP, FP-C, CMTE, Chattanooga, TNJena Billig, BSN, RN, CCRN, CFRN, Idaho Springs, Colorado

ESC TV Today brings you concise analysis from the world's leading experts, so you can stay on top of what's happening in your field quickly. This episode covers: Cardiology This Week: A concise summary of recent studies Long-term beta blockers after myocardial infarction Pros and Cons of the microaxial pump in cardiogenic shock Snapshots Host: Perry Elliott Guests: Stephan Achenbach, Carlos Aguiar, Michael Boehm, Lene Holmvang Want to watch that episode? Go to: https://esc365.escardio.org/event/1151   Disclaimer This programme is intended for health care professionals only and is to be used for educational purposes. The European Society of Cardiology (ESC) does not aim to promote medicinal products nor devices. Any views or opinions expressed are the presenters' own and do not reflect the views of the ESC. Declarations of interests Stephan Achenbach, Michael Boehm, Lene Holmvang and Nicolle Kraenkel have declared to have no potential conflicts of interest to report. Carlos Aguiar has declared to have potential conflicts of interest to report: personal fees for consultancy and/or speaker fees from Abbott, AbbVie, Alnylam, Amgen, AstraZeneca, Bayer, Boehringer-Ingelheim, Daiichi-Sankyo, Ferrer, Gilead, Lilly, Novartis, Pfizer, Sanofi, Servier, Tecnimede. Davide Capodanno has declared to have potential conflicts of interest to report: Abbott Vascular, Novo Nordisk, Sanofi. Terumo, Medtronic. Emma Svennberg has declared to have potential conflicts of interest to report: institutional research grants from Abbott, Astra Zeneca, Bayer, Bristol-Myers, Squibb-Pfizer, Boehringer-Ingelheim, Johnson & Johnson, Merck Sharp & Dohme.

An Impella update, another TAVI vs SAVR trial, two studies on angina and PCI, another null substudy from REVIVED-BCIS, and semaglutide are the topics John Mandrola, MD, covers in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Impella Update CHRIP BCIS 3 https://classic.clinicaltrials.gov/ct2/show/NCT05003817 Danger-Shock Podcast https://www.medscape.com/viewarticle/1000675 II. TAVI vs SAVR Notion 2 Trial EHJ https://doi.org/10.1093/eurheartj/ehae331 DEDICATE-DZHK6 III. Angina and PCI Orbita 2 Sub-analysis Orbita Star https://www.jacc.org/doi/10.1016/j.jacc.2024.04.001 IV. Complete Revascularization Main REVIVED trial https://www.nejm.org/doi/full/10.1056/NEJMoa2206606 JACC Substudy https://www.jacc.org/doi/10.1016/j.jacc.2024.04.043 V. Semaglutide Semaglutide CV Benefits Irrespective of Weight Loss: 4-Year SELECT Data https://www.medscape.com/viewarticle/semaglutide-cv-benefits-irrespective-weight-loss-4-year-2024a100095z Nature Med substudy https://www.nature.com/articles/s41591-024-02996-7 SELECT Main paper https://www.nejm.org/doi/full/10.1056/NEJMoa2307563 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

In this in-depth episode, cardiac nursing expert Sean from the Nurse Dose Podcast vividly illustrates how acute coronary syndromes, valve dysfunction, arrhythmias, and mechanical complications can all culminate in cardiogenic shock. You'll learn to spot the ominous signs like falling cardiac output, rising filling pressures, and poor end-organ perfusion. But most importantly, Sean equips you with the critical interventions - from revascularization to advanced circulatory support devices like balloon pumps and Impella pumps. Whether you're an ICU nurse or just want to solidify your knowledge of this high-stakes condition, this masterclass on cardiogenic shock is a must-listen. This episode is part of Nurses' PodCrawl 2024. Check out other episodes from these excellent nurse podcasters: Obstructive Shock: Critical Care Scenarios and Rapid Response RN Distributive shock: Straight A Nursing and How Not to Kill Your Patient Hypovolemic shock: The Q Word Podcast and Up My Nursing Game From this episode: Listen to the Nurse Dose Podcast Check out Nurse Dose on IG! @NurseDosePodcast Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products. Do you need help with your resume, interviewing, or need career coaching? Check out Sarah at New Thing Nurse: Get 15% off of her resume and cover letter templates using the promo code UPMYGAME Nursing students and new grad career services  Experienced RN career services NP career services

Beyond logistics, safe transport requires effective communication, thorough planning and a commitment to continual learning. Today, Shane Turner is joined by Billy Thompson, a seasoned flight nurse with extensive experience in managing Impella patients. Plus, Shane and Billy explore key considerations such as assessing patient stability and properly securing the Impella console. Whether you're a seasoned transport professional or new to the field, this episode provides invaluable insights to ensure the safe and effective transport of these complex patients.

ACC Recap #1: DanGer Shock (plus a sobering JAMA research letter on Impella use), REDUCE-AMI, PREVENT, and EMPACT-MI are the topics John Mandrola, MD, covers in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. DanGer-Shock Trial Impella CP Improves Survival in STEMI, Cardiogenic Shock https://www.medscape.com/viewarticle/impella-cp-improves-survival-stemi-cardiogenic-shock-2024a10006kz Impella Saves Lives in Cardiogenic Shock, but Patient Selection Key https://www.medscape.com/viewarticle/1000659 Published DanGer Shock Study  https://www.nejm.org/doi/full/10.1056/NEJMoa2312572 JAMA Research letter https://jamanetwork.com/journals/jama/article-abstract/2817457 II. REDUCE-AMI Trial New Data Question Beta-Blockers Post-MI With Preserved EF https://www.medscape.com/viewarticle/new-data-question-beta-blockers-post-mi-preserved-ef-2024a10006y8 Beta-Blockers Post-MI Past Their Expiration Date: REDUCE-AMI https://www.medscape.com/viewarticle/1000663 REDUCE-AMI paper https://www.nejm.org/doi/full/10.1056/NEJMoa2401479 Meta-analysis: Beta Blockers for MI https://doi.org/10.1016/j.amjmed.2014.05.032 III. PREVENT Trial Preventive PCI for Vulnerable Plaques Reduces Cardiac Events https://www.medscape.com/viewarticle/preventive-pci-vulnerable-plaques-reduces-cardiac-events-2024a10006tc Preventive Coronary Stents: Not There Yet https://www.medscape.com/viewarticle/preventive-coronary-stents-not-there-yet-2024a10006yr PREVENT https://doi.org/10.1016/S0140-6736(24)00413-6 IV. EMPACT MI trial of Empagliflozin in the Post-MI setting Empagliflozin Fails to Reduce Events After Acute MI https://www.medscape.com/viewarticle/empagliflozin-fails-reduce-events-after-acute-mi-2024a10006kn EMPACT-MI: Another SGLT2 Inhibitor Miss in Post-MI Care  https://www.medscape.com/viewarticle/1000684 EMPACT MI https://www.nejm.org/doi/10.1056/NEJMoa2314051 DAPA MI https://evidence.nejm.org/doi/full/10.1056/EVIDoa2300286 PARADISE MI https://www.nejm.org/doi/full/10.1056/NEJMoa2104508 Kaul thread https://x.com/kaulcsmc/status/1776611935842165029 Kaul paper https://www.ahajournals.org/doi/full/10.1161/circulationaha.116.022537 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Memorial Hermann Life Flight created an innovative approach to improving patient care and transport efficiency for critically ill patients requiring Impella support. Go behind the scenes to discover how their program's transition to independently transporting patients with Impella devices has led to reduced transport times and enhanced patient outcomes. Plus, gain valuable insights and recommendations for implementing similar models in your transport program.In this episode:Diana Draehn, Abiomed Critical Care Team Trainer, Dallas, TXRudy Cabrera, Director and Chief Flight Nurse, Memorial Hermann Life FlightTony Herrera, Clinical Educator, Memorial Hermann Life FlightNPS-4298

As members of Abiomed's Critical Care Transport Team, we know that every transport is a lifeline, and every moment counts in our mission to recover hearts and save lives. Inside Impella: Transport Talks is a podcast where we equip you with knowledge and confidence as you transport Impella patients. Subscribe now for monthly episodes offering best practices, valuable lessons, and camaraderie. Let us be your companion as you focus on what truly matters: patient recovery and saving lives beyond the hospital walls.

Host Sarah Lorenzini and Christian Guzman APRN are back to conclude this three-part heart failure series by examining the use of mechanical circulatory support for cardiogenic shock. This episode expands on the topics covered in previous parts, focusing on the application of mechanical circulatory support methods like the intra-aortic balloon pump, Impella, CentriMag, LVADs, and ECMO.Christian and Sarah review the risks and benefits of each device, when to use them, and the key factors that impact these decisions. They also address the ethical challenges of ECMO, including the clinical judgment involved when determining who's a good candidate and when to escalate care.By the end of this episode, you'll understand how these devices function, their critical role in managing cardiogenic shock in heart failure patients, and the value nurses bring to a multidisciplinary team.Tune in for a knowledge-packed finale of this comprehensive heart failure series!Topics discussed in this episode:The role of mechanical circulatory support devicesBenefits and risks of the intra-aortic balloon pump and Impella deviceHow to properly use Impella devicesCentriMag and Left Ventricular Assist Devices (LVADs)The evolution of permanent LVADsExtracorporeal Membrane Oxygenation (ECMO) for cardiac supportChallenges and ethical considerations of ECMOThe importance of nursing knowledge and confidenceConnect with Christian Guzman APRN on Instagram:https://www.instagram.com/thenerdynursepractitioner/Watch this episode on The Rapid Response RN YouTube Channel! https://www.youtube.com/@therapidresponsern/videosMentioned in this episode:Coming Soon! Rapid Response Academy: The Heart and Science of Caring for the SickClick here to learn more about the community that Sarah is building: https://www.rapidresponseandrescue.com/coming-soon-rapid-response-academy Rapid Response and Rescue Intro CourseCONNECT

Show notes at pharmacyjoe.com/episode874. In this episode, I’ll discuss what Impella purge solution can be used if the patient has a contraindication to heparin. The post 874: How Well Does a Bicarb-Based Impella Purge Solution Work for Patients With Contraindications to Heparin? appeared first on Pharmacy Joe.

Show notes at pharmacyjoe.com/episode874. In this episode, I’ll discuss what Impella purge solution can be used if the patient has a contraindication to heparin. The post 874: How Well Does a Bicarb-Based Impella Purge Solution Work for Patients With Contraindications to Heparin? appeared first on Pharmacy Joe.

CardioNerds co-founder Dr. Amit Goyal and episode leads Dr. Jaya Kanduri (FIT Ambassador from Cornell University) and Dr. Jenna Skowronski (FIT Ambassador from UPMC) discuss Complications of acute myocardial infarction with expert faculty Dr. Jeffrey Geske. They discuss various complications of acute MI such as cardiogenic shock, bradyarrythmias, left ventricular outflow tract obstruction, ruptures (papillary muscle rupture, VSD, free wall rupture), and more. Show notes were drafted by Dr. Jaya Kanduri. Audio editing by CardioNerds Academy Intern, student doctor Tina Reddy. The CardioNerds Beyond the Boards Series was inspired by the Mayo Clinic Cardiovascular Board Review Course and designed in collaboration with the course directors Dr. Amy Pollak, Dr. Jeffrey Geske, and Dr. Michael Cullen. CardioNerds Beyond the Boards SeriesCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls and Quotes - Complications of Acute Myocardial Infarction Sinus tachycardia is a “harbinger of doom”! The triad for RV infarction includes hypotension, elevated JVP, and clear lungs. These patients are preload dependent and may need fluid resuscitation despite having an elevated JVP. Bradyarrythmias in inferior MIs are frequently vagally mediated. The focus should be on medical management before committing to a temporary transvenous pacemaker, such as reperfusion, maintaining RV preload and inotropy, avoiding hypoxia, and considering RV-specific mechanical circulator support (MCS). Worsening hypotension with inotropic agents (e.g., dobutamine, epinephrine, dopamine, norepinephrine) after a large anterior-apical MI should raise suspicion for dynamic left ventricular outflow tract obstruction due to compensatory hyperdynamic basal segments. The myocardium after a late presentation MI is as “mushy as mashed potatoes”! Need to look out for papillary muscle rupture, VSD, and free wall rupture as potential complications. Papillary muscle rupture can occur with non-transmural infarcts, and often presents with flash pulmonary edema. VSDs will have a harsh systolic murmur and are less likely to present with pulmonary congestion. Free wall rupture can present as a PEA arrest. All of these complications require urgent confirmation on imaging and early involvement of surgical teams. Notes - Complications of Acute Myocardial Infarction How should we approach cardiogenic shock (CS) in acute myocardial infarction (AMI)? Only 10% of AMI patients present with CS, but CS accounts for up to 70-80% of mortality associated with AMI, usually due to extensive LV infarction with ensuing pump failure. Physical examSinus tachycardia is considered a “harbinger of doom”, when the body compensates for low cardiac output by ramping up the heart rateThe presence of sinus tachycardia and low pulse and/or blood pressure in a patient with a large anterior MI should raise suspicion for cardiogenic shockBe wary of giving IV beta blockers in this situation as negative inotropes can precipitate cardiogenic shock (Commit Trial) When interpreting a patient's blood pressure in the acute setting, it is helpful to know their baseline blood pressure and if they have a significant history of hypertension. Patients

Starting HF meds during hospitalization for HF, Impella, testosterone, and colchicine are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Starting HF Meds During Hospitalization for HF Starting Indicated Heart Failure Meds In-Hospital: Progress, Opportunities https://www.medscape.com/viewarticle/993539 - Opportunities and Achievement of Medication Initiation Among Inpatients With Heart Failure With Reduced Ejection Fraction https://www.jacc.org/doi/full/10.1016/j.jchf.2023.04.015 II. Impella - Comparative Effectiveness of Percutaneous Microaxial Left Ventricular Assist Device vs Intra-Aortic Balloon Pump or No Mechanical Circulatory Support in Patients With Cardiogenic Shock https://jamanetwork.com/journals/jamacardiology/fullarticle/2806562 - Evidence Generation for Novel Cardiovascular Devices—Putting the Horse Back in Front of the Cart https://jamanetwork.com/journals/jamacardiology/fullarticle/2806565 III. Testosterone Big Trial Reassures on Heart Safety of Testosterone in Men https://www.medscape.com/viewarticle/993322 - Cardiovascular Safety of Testosterone-Replacement Therapy https://www.nejm.org/doi/full/10.1056/NEJMoa2215025 IV. Colchicine for CV Disease Low-Dose Colchicine Approved for CVD: Now What? https://www.medscape.com/viewarticle/993578 - Efficacy and Safety of Low-Dose Colchicine after Myocardial Infarction https://www.nejm.org/doi/full/10.1056/nejmoa1912388 - Colchicine in Patients with Chronic Coronary Disease https://www.nejm.org/doi/full/10.1056/nejmoa2021372 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net