Staying Current Helps Drive Decisions During Critical Care Emergencies

As technology and patient acuity expand, cardiothoracic surgeons and their teams must understand how to use the latest pharmacologic and mechanical therapies for emergencies in the critical care setting.

Critical Care Symposium: Cutting-Edge Strategies for Cardiothoracic Critical Care Emergencies and Evolving Technologies

Sunday

8:00 a.m. – 12:00 p.m.

Room 32

Sunday’s Critical Care Symposium will provide attendees with methods and evidence-based protocols for the innovative management of multiple urgent scenarios. 

“We’ll focus on major issues that cardiothoracic surgeons have to deal with on an almost-daily basis,” said co-moderator Michael S. Firstenberg, MD, of The Medical Center of Aurora, CO. “Attendees will go home with a better understanding of the current literature, thinking, and science behind critical care challenges and of how to apply this new knowledge in their own decision-making.”

Michael S. Firstenberg, MD

Michael S. Firstenberg, MD

Among the emergencies presented will be unexpected cardiac arrest, for which outcomes have been poor. “Extracorporeal membrane oxygenation (ECMO) is an option for patients with cardiac arrest that is refractory to resuscitative measures, and recent changes in its use call for a discussion of the indications and contraindications for extracorporeal cardiopulmonary resuscitation (ECPR), as well as the identification of management protocols for venoarterial ECMO and ECPR,” said co-moderator Rita C. Milewski, MD, PhD, of the Hospital of the University of Pennsylvania in Philadelphia.  Speakers will explore resuscitation of patients with difficult arterial and venous access sites for cannulation, strategies for left ventricular venting, and recovery versus transition to another platform.  

Additionally, respiratory emergencies with hemodynamic compromise often arise in the critical care setting and require cardiothoracic intervention and management. Recent studies, including the EOLIA trial, suggest that use of ECMO in certain subpopulations may offer clinical benefit to patients with acute respiratory distress syndrome (ARDS) that does not respond to conventional care.  “A review of the data from these studies, as well as new guidelines, will provide attendees with an overview of evidence-based therapy for ARDS,” said Dr. Milewski. 

Another respiratory emergency, pulmonary embolism, has multiple therapeutic options available, including thrombolytic therapy, catheter-based interventions, and surgical embolectomy. “Pulmonary embolism can be encountered in a number of clinical situations, and the spectrum of local capability and clinical urgency guides the management,” said co-moderator Subhasis Chatterjee, MD, of Texas Heart Institute at CHI Baylor St. Luke’s Medical Center in Houston.

More and more patients are taking anticoagulants, and an increasing number of anticoagulant agents are now available. Many physicians are uncertain of how to treat patients taking non-vitamin K oral anticoagulants (NOACs), especially in the critical setting. Reversal of NOACs is another challenge, and new guidelines about managing bleeding patients who take anticoagulants recently were published.  

“Cardiothoracic surgeons should understand how to deal with the consequences of these drugs and use technology for monitoring and testing,” said Dr. Firstenberg. “Attendees will learn how to take a leadership role in managing anticoagulation dilemmas.”

Attendees will have an opportunity to discuss management conundrums at their own institutions.

“We’re pulled into these challenging situations whether we practice at academic hospitals or community hospitals,” said Dr. Firstenberg. “Major decisions are difficult regardless of where we practice.” 

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