Neuro Resus

A Podcast by Shree Basu and Corrine Balit

A Podcast by Shree Basu and Corrine Balit

A podcast by two intensivists from Westmead PICU on post resuscitation care.

Monoclonal antibodies (MAbs), guided by molecular studies and personalised medicine are changing the face of clinical medicine.   They hold the promise of controlling diseases and improving survival whilst reducing the side effects of some 'traditional' therapies. MAbs are being used in conditions familiar to intensivists such as asthma, invasive candidiasis, RSV infection, reversal of novel antic...

The incidence of cancer is increasing in line with our ageing population, with a greater number of patients requiring ICU admission for support managing complications of their malignancy, it's therapy, or conditions unrelated to their underlying cancer. Despite these indications, the presence of a cancer diagnosis has been a common reason for refusal of ICU admission, or admission with treatment l...

There have been significant developments in the diagnosis and management of ischaemic stroke.    This started with trials showing a benefit for decompressive craniectomy after a malignant hemispheric stroke in patients under 60 undergoing surgery within 48 hours.    The evolution of CT and MRI have enabled us to better image not only the ischaemic core of the stroke, but also the surrounding hypo-...

People living with HIV in 2018 now have normal life expectancy if  receiving Anti-Retroviral Therapy (ART) and often require only one co-formulated pill every day to remain well.  However there are still people living with HIV who are unaware of their diagnosis; who may present with a critical illness.  Knowing who to test is essential.  The population living with HIV are also ageing and often hav...

Blood Pressure  (BP)  is one of the vit al hemodynamic parameters t hat we often aim  to optimize for critically ill patients .  O u r decisions regarding BP targets , and ensuing use  (or avoidance)  of vasopressor agents,  ma y directly impact on outcomes for the se patients.  Despite being a fundamental tenet of critical care,   t here is a  lack  of quality evidence   to suggest  optimal BP ta...

Recently, several novel glucose-lowering targets have had drugs developed. This has resulted in several new drugs that have been approved for the local market to treat hyperglycaemia in patients with type 2 diabetes. This presentation will attempt to provide: A concise summary of these drugs for an Intensive Care Physician. A pragmatic framework for what the non-Endocrinology Doctor should do with...

Frailty is a state of reduced physical, physiological and cognitive reserve. Tools to measure frailty which were developed in geriatric medicine practice, have over recent years been applied to patients admitted to the Intensive Care Unit (ICU). Studies in the ICU suggest that frailty is associated with reduced  reduced  likelihood of discharge home and reduced survival at one year. Survivors also...

This presentation will outline current Choosing Wisely projects happening in ICUs around Australia. It will also discuss the Choosing Wisely Australia campaign and its direction.

Lung Recruitment in ARDS - To be or not to be by Dr Swapnil Pawar 

International outcomes of centres performing ECLS (extracorporeal life support) are highly variable due to differences in patient selection, cannulation technique, practitioner experience and hospital volume. We describe the experience of one of the first regional intensive care units in Australia to provide both VV (veno-venous) and rescue VA ECMO (veno-arterial extra-corporeal membrane oxygenati...

Since the H1N1 influenza pandemic of 2009 there has been a dramatic increase in the number of patients receiving ECMO and in the number of hospitals that provide it. Data from the Extracorporeal Life Support Organisation (ELSO) suggests that over the last decade the number of adult patients receiving ECMO for respiratory support has increased at least 12-fold and the number of centres submitting d...

Optimising support by Dr Susanna Price

I will consider this question in two parts;    Should ECMO be considered for all patients?   Should ECMO services be provided in all ICUs?     From a patient perspective, ECMO is a highly invasive intervention and like every other intervention that we consider, the benefits it provides must outweigh its risks for it to be worthwhile.    Clearly, veno-venous and veno-arterial ECMO supports are very...

Use of Ventricular Assist Devices (VAD) and heart transplantation (HT) for end stage cardiac failure have increased significantly in recent decades. These support strategies hold inherently different risks in the face on non-cardiac critical illness, and require multidisciplinary team management.    According to INTERMACS, more than 2500 VADs/year are implanted the USA. Most implanted devices are...

Both cardiac transplantation and durable mechanical support with ventricular assist devices (VADs) have a parallel history – poor results to begin with followed by progressively improving results with more targeted immunosuppression, better recipient selection, improved diagnosis and treatment of rejection and opportunistic infections (cardiac transplantation) and a major step forward with replace...

This talk with discuss the indications for, contraindications to, and expected outcomes after heart transplant with a focus on the New Zealand and Australian experience.  I will discuss the transplant assessment process and listing criteria.  Perioperative and long term management of heart transplant patients will be covered.  Post heart transplant outcomes (morbidity and mortality) will be discus...

Talk will discuss the use of ECMO as advanced cardio-pulmonary resuscitation in the setting of refractory cardiac arrest.    The aim will be to provide useful information for those already experienced in ECPR as well as those with no experience but an interest in establishing an ECPR in their adult centre.    Topics covered will include the rationale for the use of ECPR , the evidence base and cur...

Extracorporeal membrane oxygenation assisted cardiopulmonary resuscitation (ECPR) is an effective therapy to improve outcomes for children who experience cardiopulmonary arrest. Survival after ECLS varies between 60% and 75%. For ECPR survival is lower, with 40% to 50% of children surviving ECPR. After ECPR good neurological outcomes are seen in 40% to 60% of children. This contrasts with adult pa...

Patients admitted to the ICU after cardiac arrest have, by definition, achieved ROSC. In such patients the major issues remain those of ongoing support hemodynamic and cardiorespiratory support, cerebral protection, aetiological diagnosis, and rapid intervention to deal with the underlying trigger (coronary angiography and stenting of coronary artery disease or CT pulmonary angiography and anticoa...

The good news in resuscitation is that there have not been any new advances that mandate a change in practice since the 2016 ANZCOR Guidelines. The bad news is that despite our best intent, the ever-increasing research appears unable to demonstrate improved outcomes with any particular approach. Two of the most exciting areas ( eCPR  and post-resuscitation care) are being covered in detail at sepa...

The Fellowship abroad : Dr Peta Alexander Research Fellowship : Dr Elissa Milford Simulation Fellowship : Dr Sile Smith Trauma Fellowship : Dr Fraser Magee Echo Fellowship : Dr Sebastian Knudsen

Renal Replacement Therapy: When to STARRT? by Professor Andrew Udy