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Take aways from the afternoon -consider TEE during arrest for multiple reasons including hand placement during compression (avoid the LVOT) -subclavian access with ultrasound is very useful. And so is lung u/s CardioNerds UMN Critical Care Cardiology Education Summit Yoav Karpenshif

ECPR tips from Dr. Jason Bartos -Goal 6-8min from pt arrival to ecmo flow -15-17F arterial, 25F venous -U/s access with fluoro confirmation -DPC for all pts CardioNerds UMN Critical Care Cardiology Education Summit Yoav Karpenshif Jason N. Katz

Great talk by Carlos L. Alviar MD, FACC on heart-lung interactions in the CICU -PPV ⬆️ RV afterload, ⬇️ preload and LV afterload -delayed MV associated with ⬇️ survival in CS -avoid hyperoxia -PEEP ⬇️ MR, high PEEP ⬆️PVR -avoid SIMV UMN Critical Care Cardiology Education Summit CardioNerds Yoav Karpenshif Jason N. Katz

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

Great session w/ WesElyMD and colleagues on rehumanizing care/icu liberation “Our job is to try to allow patients to get back to the life they had before the icu.” Keys=ABCDEF bundle,esp early mobility+minimizing sedation CardioNerds UMN Critical Care Cardiology Education Summit Jason N. Katz Carlos L. Alviar MD, FACC

Really useful session on myocarditis. Have to consider the dx first. Early biopsy if unstable, high grade AVB, sustained VT + recent onset of sx. UMN Critical Care Cardiology Education Summit CardioNerds Yoav Karpenshif #CCCES2023

Great case by Ricky Hansra, MD 🫀 on pregnancy and ECMO. -pregnancy is a low SVR state, pts are afterload sensitive -commonly deliver by c-section -target SpO2>95% -CVP, PCWP ⬆️ w/ contractions -⬆️flows necessary to match ⬆️CO necessary UMN Critical Care Cardiology Education Summit CardioNerds Yoav Karpenshif

Great discussion among CICU experts including Jason N. Katz Dr. Jason Bartos Ann Gage (complete with a birthday cake for Carlos L. Alviar MD, FACC ). Consensus on avoiding routine LV unloading, deep sedation. CardioNerds UMN Critical Care Cardiology Education Summit Yoav Karpenshif

Very useful talk by David M. Dudzinski MD followed by hands on session w/ PE devices. A few highlights: -syncope+PE is concerning -tPA often contradicted, 10-30% risk of major bleeding -multiple devices exist for catheter directed lysis or mech thrombectomy CardioNerds UMN Critical Care Cardiology Education Summit

We finished with a great session by Dr Courtney Bennett on noninvasive monitoring. Thanks to Dr Bennett, Andrea Elliott Jason N. Katz @garima_d7 Yoav Karpenshif & many others for leading an amazing conference! Looking forward to the 2nd annual! CardioNerds UMN Critical Care Cardiology Education Summit

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

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

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

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

Panel discussion on high risk airway including Erin Bohula Laura Methvin Carlos L. Alviar MD, FACC Elliott Miller - consider whether you truly have to intubate - consider awake tube w/ numbing + low dose fent/midaz - vasoactives hanging, +/- AV sheaths for ECMO CardioNerds #critcarecards24

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

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

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

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

We finished with an inspiring keynote by Melanie S. Sulistio, MD from UTSW Heart on humanity in medicine. The perfect bookend to an amazing conference. Thanks to all the organizers and speakers! CardioNerds CCC Enthusiasts #critcarecards24