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Live at Annual Episode 6: Day 2 highlights with Casey Albin, MD

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Description

At the end of Day 2 of our Annual Meeting in Phoenix, Casey Albin, MD gives a shout out to her highlights from today's packed program.

Contributors

  • Casey Albin, MD

    Casey Albin, MD is an Assistant Professor at Emory University School of Medicine where she is a member of the department of Neurocritical Care. She completed both her neurology residency and a fellowship in Medical Simulation at Harvard Medical School/BWH/MGH. She completed Neurocritical Care fellowship at Emory. Dr. Albin’s research interests focus on educational innovations in acute neurologic emergencies and neurocritical care. In addition to running simulation courses, she is the editor of a best-selling textbook The Acute Neurology Survival Guide and is passionate about open access neurologic education through Twitter, blogs, and podcasts. She serves on the Education Committee of the Neurocritical Care Foundation.

  1. 00:00:22
    Hello, everyone. And thank you for
  2. 00:00:23
    tuning in to live from NCS. This is
  3. 00:00:27
    Casey Elbin. I am so delighted to talk
  4. 00:00:30
    today about the incredible offerings
  5. 00:00:33
    from the conference. Today is Thursday,
  6. 00:00:36
    August 17. And so we're going to
  7. 00:00:38
    highlight just a couple of the sessions
  8. 00:00:41
    that we found were really exciting and
  9. 00:00:43
    discuss a couple of the pearls that some
  10. 00:00:45
    of the presenters shared I think we'll
  11. 00:00:49
    be really exciting and hopefully make
  12. 00:00:51
    you excited to tune in to on demand if
  13. 00:00:53
    you were not able to attend this session
  14. 00:00:55
    in person. So to start off, I think
  15. 00:00:59
    just highlighting that our keynote
  16. 00:01:00
    address was given today by Dr Mona Kumar
  17. 00:01:03
    from Penn and Dr Cara Melmed from NYU,
  18. 00:01:07
    looking at the importance of health care
  19. 00:01:10
    disparities in our neuro critical care
  20. 00:01:12
    population Such important work as we as
  21. 00:01:16
    a field seek to better understand how
  22. 00:01:19
    socio-economic racial and ethnic
  23. 00:01:22
    diversity are linked to disparities that
  24. 00:01:25
    really impact recovery and even
  25. 00:01:27
    mortality. I thought Director Kumar's
  26. 00:01:30
    talk was really interesting as it
  27. 00:01:32
    explored the impact of the current
  28. 00:01:34
    political and social factors on patient
  29. 00:01:37
    autonomy. And that was particularly
  30. 00:01:39
    looking at marginalized and minority
  31. 00:01:41
    population and neurocritical care and
  32. 00:01:43
    how the consequences of this compromised
  33. 00:01:46
    patient autonomy can impact really
  34. 00:01:48
    important outcomes like brain deaths,
  35. 00:01:50
    termination, and organ transplantation.
  36. 00:01:51
    And I think she really emphasized how
  37. 00:01:51
    organ transplant also are going to
  38. 00:01:58
    minoritized communities. And it's
  39. 00:02:00
    really important that we consider
  40. 00:02:02
    patient autonomy when we're navigating
  41. 00:02:04
    this really complicated and
  42. 00:02:09
    can be emotionally fraught aspect of
  43. 00:02:11
    kind of one of the core components that
  44. 00:02:14
    we're doing at the bedside.
  45. 00:02:16
    Dr. Malmed reviews their retrospective
  46. 00:02:18
    analysis of zip code as a marker of
  47. 00:02:20
    social determinants of health and how
  48. 00:02:22
    this impacts mortality after ICH. And I
  49. 00:02:25
    don't think their findings come really
  50. 00:02:27
    as a surprise showing that if you live
  51. 00:02:30
    in a lower socioeconomic zip code that
  52. 00:02:32
    your mortality is higher. But I think
  53. 00:02:35
    it was really important to highlight
  54. 00:02:37
    that we have hard data showing that now
  55. 00:02:39
    and how important it is given that we
  56. 00:02:41
    invest so much in the acute care of
  57. 00:02:43
    these patients that we really need to
  58. 00:02:45
    invest in their longitudinal care as
  59. 00:02:47
    well to make sure that
  60. 00:02:50
    really the benefit of all that acute
  61. 00:02:52
    care translates into longitudinal
  62. 00:02:54
    outcomes. Another of the sessions that
  63. 00:02:57
    we wanted to highlight today is the care
  64. 00:02:58
    of the cardiac patient. This is a
  65. 00:03:00
    constant source of consult stress for
  66. 00:03:02
    neurointensivists as we are called to
  67. 00:03:04
    help prognosticate and to investigate
  68. 00:03:07
    brain recovery for patients who are
  69. 00:03:10
    suffering from a cardiovascular illness
  70. 00:03:12
    So Dr. Ryan Prainer. Dr. Kara Melman
  71. 00:03:15
    and Dr. Sun Min Cho discussed the
  72. 00:03:18
    mechanical support and neuromonitoring
  73. 00:03:20
    in these patients. And I was able to
  74. 00:03:23
    talk with Dr. Cho who really gave me
  75. 00:03:26
    some pearls. This ECMO-associated brain
  76. 00:03:30
    injury is common. And in fact, a nice
  77. 00:03:32
    pearl about it is that it doubles and
  78. 00:03:34
    triples the mortality in both VA and VV
  79. 00:03:38
    ECMO patients. And there's likely a
  80. 00:03:40
    causal relationship between ECMO and
  81. 00:03:43
    acute brain injury. They discuss in
  82. 00:03:46
    this session how early detection of
  83. 00:03:48
    acute brain injury is really critical.
  84. 00:03:51
    And we really need to take a
  85. 00:03:52
    standardized approach to having a
  86. 00:03:54
    monitoring protocol with really
  87. 00:03:56
    comprehensive neurocritical care to
  88. 00:03:58
    improve the neurologic outcomes of these
  89. 00:04:00
    patients. And I think one of the really
  90. 00:04:03
    interesting and one of the things that's
  91. 00:04:05
    coming down the pipeline is how MRI can
  92. 00:04:08
    be used to substantially improve our
  93. 00:04:10
    ability to diagnose acute re-injury.
  94. 00:04:14
    Obviously, these patients can't be
  95. 00:04:16
    transported. Many of them have devices
  96. 00:04:18
    that are not safe and MRI compatible,
  97. 00:04:21
    but how the safe MRI ECMO study is
  98. 00:04:23
    really moving the needle with point of
  99. 00:04:25
    care MRI that can be done for these
  100. 00:04:27
    patients. And so that really is one of
  101. 00:04:29
    the future applications of a
  102. 00:04:31
    neuropregnostication in these patients.
  103. 00:04:34
    Another important session today was the
  104. 00:04:36
    guideline updates in the late breaking
  105. 00:04:38
    science, which covered some of the
  106. 00:04:40
    topics of
  107. 00:04:42
    delirium and rapid EEG seizure
  108. 00:04:45
    assessment and going through the safer
  109. 00:04:47
    trial. We also looked at various dual
  110. 00:04:50
    anti-apletelet therapy strategies for
  111. 00:04:53
    neuroendvascular scents. Then my
  112. 00:04:55
    colleague, Dr. Salia Farok, will
  113. 00:04:57
    review the role of ketamine in status
  114. 00:04:59
    epilepticus as a separate podcast from
  115. 00:05:01
    the Live from NCS series. So I'm gonna
  116. 00:05:04
    skip that and talk about this really
  117. 00:05:07
    exciting concurrent session, which was
  118. 00:05:09
    the road to the future and assessing the
  119. 00:05:12
    unresponsive patient. This was led by
  120. 00:05:14
    Dr. Alcarom, Dr. Klassen, and Dr.
  121. 00:05:17
    Mushlegal, who talk about how early
  122. 00:05:21
    prognostication is often inaccurate and
  123. 00:05:26
    how functional recovery is more likely
  124. 00:05:28
    if the unresponsive patient has minimal
  125. 00:05:30
    clinical signs of interaction with the
  126. 00:05:32
    environment. But figuring that out is
  127. 00:05:35
    actually really quite difficult in
  128. 00:05:37
    today's neuroassessments. And so an
  129. 00:05:40
    important pearl that they give in this
  130. 00:05:43
    session is that up to one in every five
  131. 00:05:45
    behaviorally unresponsive patients has
  132. 00:05:48
    evidence of preserved consciousness when
  133. 00:05:51
    tested with motor paradigms, utilized
  134. 00:05:54
    in functional MRI or EEG paradigms. And
  135. 00:05:58
    they really talk about this state being
  136. 00:05:59
    the state of covert consciousness. And
  137. 00:06:02
    so this session goes through the current
  138. 00:06:05
    state of detecting covert consciousness,
  139. 00:06:07
    discusses proposed mechanisms that
  140. 00:06:10
    underlie this state, insight into how
  141. 00:06:14
    using high tracking and EEG, we're
  142. 00:06:17
    going to be able in the future to better
  143. 00:06:19
    understand which of our patients are
  144. 00:06:21
    likely to make a recovery. And I think
  145. 00:06:24
    one of the things that is hard about
  146. 00:06:25
    this is that given that these are sort
  147. 00:06:27
    of novel prognostication tools and that
  148. 00:06:30
    we are going to have to learn their
  149. 00:06:32
    application, we're going to be learning
  150. 00:06:34
    that alongside the families. And how do
  151. 00:06:35
    we talk to families about this so that
  152. 00:06:38
    they can integrate this novel
  153. 00:06:40
    information into their decision making
  154. 00:06:42
    that best gives the chance for their
  155. 00:06:45
    loved one to really
  156. 00:06:49
    you know meet a standard that is
  157. 00:06:51
    acceptable to the patient and you know
  158. 00:06:52
    how do we use shared decision making in
  159. 00:06:55
    some of these novel situations. And
  160. 00:06:58
    then finally I think one of the more
  161. 00:07:00
    interesting sessions this afternoon was
  162. 00:07:03
    this critical conversations doing 360
  163. 00:07:06
    feedback in the ICU And so, Shwita
  164. 00:07:09
    Goswami at the University of Florida,
  165. 00:07:12
    you know, gave a really insightful
  166. 00:07:14
    presentation about what it means to be a
  167. 00:07:16
    trainee in a teen dynamic situation like
  168. 00:07:20
    a neurocritical care team. And so she's
  169. 00:07:23
    really gone into sort of
  170. 00:07:26
    the science of learning how to be a
  171. 00:07:28
    member of a highly functioning team.
  172. 00:07:30
    And that's really important because as a
  173. 00:07:32
    neurocritical care trainee, you're not
  174. 00:07:34
    just becoming a neurointensivist,
  175. 00:07:35
    you're training to become the leader of
  176. 00:07:37
    a multidisciplinary team. And so she
  177. 00:07:40
    gives a sort of broad overview of some
  178. 00:07:42
    of the really, you know, behavioral
  179. 00:07:45
    like science-based tenets of a
  180. 00:07:48
    high-performing team such as leadership
  181. 00:07:50
    style and establishing psychological
  182. 00:07:53
    safety and using emotional intelligence
  183. 00:07:55
    and how do you establish mutual
  184. 00:07:57
    accountability in the care of these
  185. 00:07:59
    patients? Because we are all caring for
  186. 00:08:03
    a neurocritical care patient as a team
  187. 00:08:05
    and each member of that team has to
  188. 00:08:08
    really contribute so that the patient
  189. 00:08:10
    gets the best outcome. So I thought
  190. 00:08:12
    that was a really exciting session as
  191. 00:08:14
    well. There are many, many more
  192. 00:08:16
    sessions that we obviously could not
  193. 00:08:17
    highlight all. And today's live from
  194. 00:08:20
    NCS podcast, but I do hope that you'll
  195. 00:08:22
    check out the schedule. And I hope that
  196. 00:08:23
    if you missed some of these exciting
  197. 00:08:26
    sessions that we've featured here, that
  198. 00:08:28
    you'll be able to catch them on demand.
  199. 00:08:30
    All right, until tomorrow.