Dr. Shannon Fernando is an intensivist at Lakeridge Health and a prolific researcher with over 150 publications. Known for his work in outcomes-based research across critical care, he joins us to discuss long-term outcomes after cardiogenic shock.
About the Episode:
This episode is part of our cardiovascular critical care series and explores what happens after the ICU for patients who survive cardiogenic shock. We unpack quality of life, functional outcomes, mental health, and the hidden burdens on both patients and caregivers. Dr. Fernando provides key data insights from his large cohort studies and shares reflections from ICU follow-up clinics. We also dive into the challenges of prognostication and how to communicate realistic expectations to families.
Topics Covered
Defining Long-Term Outcomes:
Key Findings from Ontario Cohort
Morbidity and Quality of Life
Prognostic Factors and Predictive Markers
ICU Follow-Up Clinics
Emphasizing trajectory over fixed timelines
Rethinking Endpoints in Research
Equipping clinicians and patients with realistic expectations
In this episode, recorded live at CCCF 2024, we sit down with Dr. Emilie Belley-Côté, a cardiac intensivist, researcher, and clinical trialist from McMaster University, to unpack cardiogenic shock: the SCAI classification.
Whether you're in the ED, cath lab, or ICU, the SCAI (Society for Cardiovascular Angiography and Interventions) stages offer a common language to describe the severity of cardiogenic shock, guide escalation of care, and improve outcomes through structured assessment.
Dr. Belley-Côté walks us through:
The five SCAI stages (A through E): what they mean and how they’re used.
How this classification system improves communication between specialties.
The importance of recognizing patients in pre-shock (Stage B) before they deteriorate.
Real-world application: how SCAI staging intersects with clinical signs, biomarkers, and hemodynamic monitoring.
Where the SCAI classification fits in research, including trials evaluating mechanical circulatory support and advanced heart failure therapies.
With Dr. Belley-Côté’s clear explanations and insights from the front lines of cardiac critical care, this episode is essential listening for anyone managing unstable cardiac patients.
In this episode, we’re joined by Dr. James Downar, a leading Canadian voice in palliative and critical care, for a wide-ranging discussion on the emerging role of psychedelics in managing psychological and existential distress.
Psychedelics have gone from fringe to forefront in recent years, and we dig into what that shift might mean for patients facing critical illness or the end of life.
What psychedelics are and how they work
Substances like psilocybin, LSD, ketamine, and MDMA
Key effects: altered perception, ego dissolution, and emotional insight
Risks and benefits in vulnerable populations
Psychedelic-assisted therapy: structure and process
The three-phase model: preparation, the session itself, and integration
Micro dosing vs. full therapeutic sessions
Where current evidence stands
Potential applications in critical care and palliative medicine
Helping patients process fear, isolation, and suffering
How psychedelics differ from traditional symptom management tools like opioids
Limitations in advanced illness due to physiological concerns
Research and implementation challenges
Problems with study design and placebo controls
The importance of ‘set and setting’
Defining success in existential or spiritual distress
Ethical considerations and clinical integration
Balancing innovation with compassion and caution
Avoiding reductionism: why psychedelics should complement—not replace—human care
The future role of these therapies in ICU and palliative settings
Recorded live at the Canadian Critical Care Forum 2024 in Toronto, this episode dives into the complex world of ischemia-reperfusion syndrome — the paradox where restoring blood flow causes further injury. We explore the underlying mechanisms, clinical implications, and future directions in managing this phenomenon.
Joining us for the third time is Prof. Mervyn Singer, ICU physician, researcher, and thought leader in critical care physiology. Known for challenging dogma and making complex science accessible, Prof. Singer unpacks this important topic with clarity and insight.
Dr. Mike Christian is a critical care and pre-hospital medicine specialist with extensive experience in aeromedical transport and military medicine. His diverse career spans work as a paramedic, internal medicine and critical care training, and roles as a flight physician with London Air Ambulance and the Canadian military. He is a leading advocate for integrating interprofessional teams and advancing physician-led pre-hospital care in Canada. Currently, he is involved in the MedResponse BC initiative, which aims to enhance critical care delivery outside of hospitals.
In this episode, Peter and Leon sit down with Mike to explore the evolving landscape of pre-hospital critical care. From his unconventional career path to the integration of AI in emergency response, he shares insights on improving outcomes in pre-hospital medicine and the lessons Canada can learn from global high-performance systems.
Key Topics & Chapters
Mike’s Career Journey
Pre-Hospital Critical Care: Canada vs. The World
The Role of Physicians in Pre-Hospital Medicine
The Role of the Physician in Pre Hospital Medicine.
Future Directions in Pre-Hospital Medicine
Keywords:
Pre-hospital care, critical care transport, HEMS, trauma response, paramedics, physician-led pre-hospital medicine, telemedicine, AI in emergency medicine, interprofessional teams, rural emergency care, GoodSAM app, London Air Ambulance, MedResponse BC.
Links of Interest:
In this episode, hosts Leon Byker and Peter Brindley are joined by Dr. Elizabeth Viglianti, an assistant professor at the University of Michigan, Pulmonologist and Critical Care Specialist, to discuss the crucial issue of gender based harassment in medicine.
Gender-Based Harassment refers to any unwelcome behavior, comment, or conduct that demeans, intimidates, or disadvantages someone based on their gender or gender identity. This can include derogatory remarks, exclusion, stereotyping, unequal treatment, or threats, whether or not the behavior is sexual in nature. In the workplace, it undermines professional dignity and contributes to a hostile or inequitable environment.
Dr. Viglianti shares her personal experience that led her to study this field, detailing the prevalence and impact of such harassment. The discussion covers key findings from the National Academies of Science, Engineering, and Medicine's framework on addressing sexual and gender based harassment, gender disparities, organizational factors contributing to harassment, and her research on the topic. Practical steps and recommendations for institutions to mitigate harassment are also explored.
00:00 Introduction and Welcome
01:08 Personal Experience with Sexual Harassment
03:06 Understanding Gender Based Harassment in Medicine
05:34 Organizational Factors and Solutions
07:50 Gender Disparities in Academic Medicine
17:42 Impact on Trainees and Reporting Challenges
24:46 Addressing Patient-Perpetrated Harassment
28:59 Practical Strategies and Training
32:26 Conclusion and Call to Action
We take another break as we are joined by Prof. Wendy Sligl, formidable ID and ICU doc, to discuss the critical topic of optimizing antibiotic prescribing in critical care settings.
The discussion covers various aspects of antibiotic use, including the importance of timely administration, the role of communication in ensuring effective treatment, and the nuances of dosing strategies such as loading doses and continuous infusions. The conversation also delves into the duration of antibiotic therapy, emphasizing the need for individualized treatment based on patient response.
Takeaways:
Chapters:
00:00
Introduction to Antibiotic Optimization
01:07
Understanding Infections and Sepsis
02:47
Emergency Room Protocols for Antibiotic Administration
04:56
Identifying Sepsis and Administering Antibiotics
06:33
Communication and Timeliness in Antibiotic Delivery
08:42
Optimizing Antibiotic Dosing Strategies
10:59
Pharmacodynamics and Continuous Infusions
12:44
Duration of Antibiotic Therapy
18:52
Monitoring and Adjusting Antibiotic Treatment
21:39
The Debate on Antibiotic Duration
26:37
Specific Infections and Treatment Duration
31:24
Practical Strategies for Antibiotic Stewardship
32:43
Rapid Fire Questions on Antibiotic Use
Following the discussion on ECLS in AMI and cardiogenic shock, we go on to discuss eCPR for cardiac arrest specifically. This episode was recorded live at the Critical Care Canada Forum 2024 as part of our special series on cardiac intensive care.
Our guest is Dr. Darryl Abrams, Associate Medical Director and Director of Research for the Medical ECMO Program at New York-Presbyterian/Columbia University. Dr. Abrams joins us for an in-depth discussion on the current state and future direction of extracorporeal cardiopulmonary resuscitation, or eCPR.
We dive into the complex world of eCPR in refractory cardiac arrest, starting with a breakdown of the three landmark trials that have shaped the field: the ARREST trial, the Prague OHCA trial, and the INCEPTION trial. Each study offers a unique perspective, from the dramatic early findings of ARREST to the pragmatic design of Prague OHCA and the sobering multicenter outcomes of INCEPTION.
A major theme throughout the episode is the role of system design. Dr. Abrams emphasizes the importance of minimizing low-flow time, rapid cannulation, and consistent team expertise—factors that can make or break the success of eCPR.
We also explore the ethical and practical considerations that come with rolling out such a resource-intensive intervention, including the balance between innovation and equity. Is it fair that access to eCPR may depend on geography or institutional resources? And how do we make meaningful improvements in survival when only a few centers can offer this advanced care?
The episode closes with a practical lens: how should clinicians approach building an ECMO program? What are the essential pieces that need to be in place before considering eCPR? And how do you select patients in a way that balances risk, benefit, and system capacity?
Chapters:
Introduction and guest welcome
Setting the scene: What is eCPR and why now?
The ARREST trial: Small study, big impact
The Prague OHCA trial: Early randomization, broader population
The INCEPTION trial: Multicenter reality and negative results
Comparing the evidence: Why do outcomes differ?
Low-flow time and speed of cannulation
The role of meta-analyses and what they do (and don’t) tell us
Opportunity cost: What are we giving up to fund eCPR?
Duration of support: How long is too long?
Will there be another trial? Challenges of equipoise
Building a responsible eCPR program
Patient selection: Who qualifies and why?
Cannulation techniques and adjunct devices
System design: U.S. vs. Canada vs. U.K.
Ethical concerns and access inequities
Guidelines and final takeaways
In this episode, recorded live at the Critical Care Canada Forum in Toronto, we dive into extracorporeal life support (ECLS) in cardiogenic shock, with Dr Sean van Diepen.
He is an Associate Professor at the University of Alberta, Co-Director of the CCU at the Mazankowski Alberta Heart Institute, and a leading voice in cardiac critical care.
Join us as we explore the evolving landscape of mechanical circulatory support, the latest evidence from the DANGER and ECLS-SHOCK trials, and the complexities of patient selection.
Key Topics Covered:
1. The Evolution of ECLS in Cardiogenic Shock
• The 25-year gap since the last positive cardiogenic shock trial.
• How mechanical circulatory support expanded despite limited evidence.
2. The DANGER Trial – Impella in AMI-Associated Cardiogenic Shock
• Mechanism and function of the Impella device.
• Trial results: 20% mortality reduction at 180 days.
• Complications: Limb ischemia, hemolysis, and high costs.
• Real-world application: Who actually qualifies?
3. ECLS-SHOCK Trial – ECMO for Cardiogenic Shock
• A "negative" trial, but a crucial wake-up call.
• No mortality benefit but significantly higher complication rates.
• Controversies: Inclusion of cardiac arrest patients and transition to destination therapy.
• Future directions: Can patient selection improve outcomes?
4. ECPR – Extracorporeal Support in Refractory Cardiac Arrest
• Review of the ARREST, PRAGUE, and INCEPTION trials.
• Why the evidence remains unclear and institution-dependent.
• The role of high-volume ECMO centers and standardized pathways.
5. The Future of ECLS – Cost, Ethics, and Decision-Making
• How should institutions decide who gets ECMO?
• The role of cardiogenic shock teams.
• Could AI play a role in decision-making?
• The challenge of resource allocation in a single-payer system.
Key Takeaways:
✅ Impella shows promise in carefully selected AMI shock patients but is costly and high-risk.
✅ ECMO for cardiogenic shock remains controversial—patient selection is key.
✅ ECPR is promising but needs further trials and structured implementation.
✅ Cardiogenic shock management should be a team decision, not an individual one.
🔊 Listen now and join the conversation on the future of cardiac critical care!
We’re taking a break from our Cardiac Critical Care series to bring you a conversation with one of the most influential figures in medicine.
Peter had the huge privilege of interviewing Major General Tim Hodgetts, the recently retired, most senior medical advisor in the UK forces.
Hodgetts shares his remarkable journey in transforming emergency medicine from its infancy to maturity, detailing poignant experiences from his early career that steered him towards this specialty. The discussion ranges from Hodgetts' pioneering efforts in combat casualty care, the evolution of battlefield first aid, and innovative medical practices in conflict zones, to his concepts on leadership, international collaborations, and coping with trauma.
The segment also touches on Hodgetts' recent retirement and his ongoing contributions to medical and military communities through teaching, charity work, and writing.
Chapters:
00:00 Introduction and Guest Overview
02:56 Early Career and Influences
06:25 Pioneering Emergency Medicine in the Military
08:13 Revolutionizing Combat Casualty Care
17:55 International Collaboration and Cultural Insights
30:31 Leadership in Crisis
35:35 Coping with Trauma and Personal Reflections
39:43 Retirement and Legacy
42:29 Conclusion and Final Thoughts
This has been one of my absolute favorite podcasts to produce! What an honor to have Major General Tim Hodgetts join us on the Critical Care Commute!
Recorded live at the Critical Care Canada Forum 2024, this episode is part of our special Cardiac ICU Series.
Dr. Rebecca Mathew, cardiologist and critical care specialist at the University of Ottawa Heart Institute, joins us to discuss the latest refractory cardiac arrest practice updates, including antiarrhythmic drugs, defibrillation strategies, and the role of ECPR.
Chapters:
• Defining refractory cardiac arrest
• Antiarrhythmic drugs: amiodarone vs. lidocaine
• Defibrillation strategies: vector change and double sequential defibrillation
• Emerging therapies: stellate ganglion blocks and electrical storm management
• ECPR: who qualifies and what the trials say
• Equity and feasibility challenges in cardiac arrest management
• ICU recovery clinics and patient-centered outcomes
• Clinical trials: barriers to enrollment and the need for change
References:
1. ROC ALPS Trial: 1. Kudenchuk PJ, Brown SP, Daya M, et al. Resuscitation Outcomes Consortium-Amiodarone, Lidocaine or Placebo Study (ROC-ALPS): Rationale and Methodology Behind an Out-of-Hospital Cardiac Arrest Antiarrhythmic Drug Trial. American Heart Journal. 2014;167(5):653-9.e4. doi:10.1016/j.ahj.2014.02.010. PMID: 24766974.[1]
2. DOSE VF: Cheskes S, Drennan IR, Turner L, Pandit SV, Dorian P. The Impact of Alternate Defibrillation Strategies on Shock-Refractory and Recurrent Ventricular Fibrillation: A Secondary Analysis of the DOSE VF Cluster Randomized Controlled Trial. Resuscitation. 2024;198:110186. doi:10.1016/j.resuscitation.2024.110186. PMID: 38522736
3. ARREST: Yannopoulos D, Bartos J, Raveendran G, et al. Advanced Reperfusion Strategies for Patients With Out-of-Hospital Cardiac Arrest and Refractory Ventricular Fibrillation (ARREST): A Phase 2, Single Centre, Open-Label, Randomised Controlled Trial. Lancet (London, England). 2020;396(10265):1807-1816. doi:10.1016/S0140-6736(20)32338-2. PMID: 33197396
4. INCEPTION: Ubben JFH, Suverein MM, Delnoij TSR, et al. Early Extracorporeal CPR for Refractory Out-of-Hospital Cardiac Arrest - A Pre-Planned Per-Protocol Analysis of the INCEPTION-trial. Resuscitation. 2024;194:110033. doi:10.1016/j.resuscitation.2023.110033. PMID: 37923112
Disclaimer:
This episode is for educational purposes only and does not constitute medical advice. The views expressed are those of the hosts and guests and do not necessarily reflect their employers.
Welcome to our first episode in a series on Cardiac Intensive Care, recorded live at the Critical Care Canada Forum 2024. We kick off by looking at the latest Clinical Practice Update on post cardiac arrest care and refractory cardiac arrest.
The "Canadian Cardiovascular Society/Canadian Cardiovascular Critical Care Society/Canadian Association of Interventional Cardiology Clinical Practice Update on Optimal Post Cardiac Arrest and Refractory Cardiac Arrest Patient Care" CCS was published in 2024, and provides comprehensive recommendations for the management of patients following cardiac arrest.
Join us as Dr Janek Senaratne unpacks this Clinical Practice Update (CPU), and guides us through the evidence for the recommendations made.
Dr. Janek Senaratne is a dual-trained cardiologist and intensivist based in Edmonton, Alberta. He serves as an Associate Clinical Professor in the Department of Medicine at the University of Alberta. University of Alberta In his clinical roles, Dr. Senaratne practices at the University of Alberta Hospital and Grey Nuns Hospital, and is one of the Vital Heart Response physicians for the province.
Further Reading:
Recorded live at the Toronto Critical Care Canada Forum, this episode features a conversation with Prof. Derek Angus, Professor at the University of Pittsburgh, senior editor at JAMA, and Vice Chair of Innovation.
We discuss the evolution of healthcare systems, the art of decision-making, the role of AI, and how to inspire the next generation of clinicians.
Chapters:
Welcome to the Forum
Conferences: More Than Just Science
Reflections on the digital age: Do we risk dumbing things down too much?
The AI Frontier in Medicine
Thinking, Fast and Slow
Redefining Careers in Medicine
Building Better Healthcare Systems
Closing Thoughts
Health Economics 101: "Code Green - How the big lie in health care affects us all."
Prof. John Kellum, is a Professor of Critical Care Nephrology and now provocative author! Join us as he talks to us about his book: "Code Green - How the Big Lie in Healthcare Affects Us All."
Conflict Declaration:
The hosts and producers of this podcast declare no financial gain or conflict of interest from this episode or the promotion of Code Green. Our only goal is to share the insights and expertise of Dr. Kellum with our audience.
Episode Chapters:
Further Resources:
• Code Green: How the Big Lie in Healthcare Affects Us All
In this episode, we dive into the fascinating world of Hyperbaric medicine with Dr. Jeff Kerrie, a Hyperbaric specialist from British Columbia, Canada.
Dr. Kerrie takes us through the science, history, and practical applications of Hyperbaric oxygen therapy (HBOT) as we explore the approved indications, physiological effects, and logistics of managing hyperbaric chambers.
Episode Chapters:
Introduction
Meet Dr. Jeff Kerrie and learn about his journey in hyperbaric medicine and the unique setup of Vancouver Island’s hyperbaric program.
History of Hyperbaric Medicine
A look at the origins of hyperbaric therapy, from 1600s pressurized chambers to its modern evolution.
The Physiology of HBOT
Understanding the effects of supra-physiologic oxygen pressures on microcirculation, angiogenesis, and inflammation.
Indications and Evidence:
Decompression Sickness
The mechanisms of treating “the bends” and why HBOT works so effectively.
Air or Gas Embolism
Insights into diagnosing and treating air embolism, including critical resuscitation tips.
Carbon Monoxide Poisoning
How HBOT prevents long-term neurological damage, with considerations for pregnant patients and associated toxins like cyanide.
Necrotizing Soft Tissue Infections
The role of HBOT in treating Fournier’s gangrene and clostridial infections alongside surgery.
Crush Injuries and Anemia
Exploring HBOT’s utility in tissue salvage and sustaining oxygenation in severe anemia.
Newer Indications: Sudden Hearing and Vision Loss
The emerging role of HBOT in sudden sensorineural hearing loss and central retinal artery occlusion.
Risks and Safety in the Chamber
Barotrauma, oxygen toxicity, fire safety, and managing emergencies during dives.
Logistics of Hyperbaric Medicine
A behind-the-scenes look at hyperbaric chamber setups, patient care protocols, and equipment considerations.
Closing Thoughts
Dr. Kerrie’s perspective on the future of hyperbaric medicine and ongoing research opportunities.
Key Indications for HBOT:
1. Decompression sickness ("The Bends")
2. Air or gas embolism
3. Carbon monoxide poisoning
4. Necrotizing soft tissue infections
5. Crush injuries and compartment syndromes
6. Severe anemia (e.g., in patients unable to receive transfusions)
7. Radiation tissue injury (e.g., osteoradionecrosis)
8. Sudden sensorineural hearing loss
Resources and Links:
Disclaimer:
This episode provides general information and is not a substitute for professional medical advice. Always consult with a specialist for specific clinical decisions.
In this episode, Peter Brindley and Leon Byker sit down with Dr. Rob Bevan, immediate past president of the College of Intensive Care Medicine (CICM) and Critical Care Director at Auckland City Hospital, Auckland, New Zealand.
Dr. Bevan shares his journey through leadership in intensive care, the role of intensive care colleges, and the evolution of critical care training. He also explores the political, social, and ethical dimensions of critical care, from workforce sustainability to the unique role of intensivists as brokers of care.
Episode Highlights:
The Evolution of CICM: History of the CICM and the differences between the CICM and similar organizations globally.
Training for Critical Care: The training pipeline in Australasia.
Advocacy and Political Engagement: The role of the CICM in advocating for intensive care resources.
The Value of College Convocations: Celebrating new fellows and their families and the role of meaningful ceremonies.
The Intensivist as a Broker of Care: Defining the role of the ICU specialist in complex patient care.
The Future of Critical Care Workforce: Addressing workforce challenges and it's sustainability.
The Upcoming CICM Annual Meeting: Highlights of the upcoming 2025 meeting in Tasmania.
Reflections on Leadership and Administration: Dr Bevan's Journey into administration and why it matters.
Coping with dying and saying what needs to be heard: Elliot Sprague
Introduction: In this emotional episode, Peter Brindley, Leon Byker, and Elliot Sprague revisit Elliot’s journey with metastatic cancer, a year after his initial appearance on the podcast,
Elliot reflects on the impact of living with a terminal illness, sharing life lessons, and offering insights on how he continues to thrive despite a difficult prognosis. This episode Elliot talks about acceptance, gratitude, and the importance of living each moment fully.
Topics Discussed:
Timeline:
Thank you Elliot for joining us!
https://www.gofundme.com/f/dr-elliott-sprague-and-family?attribution_id=sl:c52d4c83-2649-4ce0-a003-651776f01205&utm_campaign=man_sharesheet_ft&utm_medium=customer&utm_source=email
In this episode, we sit down with Dr. Damon Scales and Dr. Niall Ferguson at the Canadian Critical Care Forum. We dive into a little bit of ARDS and spend a whole lot of time talking about the evolving landscape of conferences and critical care research. Tune in for insights from two leaders in the field!
Join us as Prof. Stephen Lapinski answers our questions on Obstetric critical care.
Stephen Lapinsky is Director of the Intensive Care Unit at Mount Sinai Hospital, Toronto and Professor of Medicine at the University of Toronto. He graduated from the University of the Witwatersrand, Johannesburg, and trained in Pulmonary and Critical Care Medicine. His clinical practice includes general Critical Care Medicine and ambulatory Respirology. He has a clinical and research interest in critical illness and respiratory disease in the pregnant patient. He is an officer of the North American Society of Obstetric Medicine (NASOM) and is co-Editor-in-Chief of the international journal Obstetric Medicine.
Join us as we discuss ARDS, Research and balancing life as a researcher with Professor Charlotte summers, Director of the Heart and Lung Research Institute (HLRI).
