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  3. Live at Annual Episode 8: L...

    Live at Annual Episode 8: Last day wrap-up with Casey Albin, MD

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    Description

    We've had a blast in Phoenix and Casey Albin brings our podcast proceedings to a close with her highlihghts from the third and final day of #NCS2023. See you next year in San Diego (October 14-18, 2024)!

    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
      Hi everyone and welcome back. This is
    2. 00:00:24
      another episode of the live from annual
    3. 00:00:26
      podcast. So delighted to kind of recap
    4. 00:00:29
      a couple of the highlights from today.
    5. 00:00:32
      This is Friday, August 18th. And
    6. 00:00:35
      there's so many episodes, so many
    7. 00:00:37
      sessions that could be highlighted. But
    8. 00:00:38
      wanted to take a minute to just
    9. 00:00:39
      highlight three that I thought were
    10. 00:00:41
      really exciting and innovative and kind
    11. 00:00:43
      of offered a good insight into the
    12. 00:00:46
      future of neurocritical care. So there
    13. 00:00:48
      was another really exciting session
    14. 00:00:50
      about non-invasive ICP monitoring and
    15. 00:00:53
      the future of non-invasive ICP
    16. 00:00:55
      monitoring. This was really cool. Like
    17. 00:00:57
      this is just looking at some of the
    18. 00:00:59
      latest and greatest in terms of
    19. 00:01:02
      what might be coming down the pipeline
    20. 00:01:05
      to help us non-invasive measure ICP.
    21. 00:01:08
      And so this was led by Dr. Prussella,
    22. 00:01:11
      Dr. Herzala, and Dr. Puccio, who
    23. 00:01:14
      each talk about
    24. 00:01:21
      sort of novel approach to non-invasive
    25. 00:01:23
      ICB monitoring. So Dr. Brazil talked
    26. 00:01:25
      about some of his work in looking at a
    27. 00:01:30
      new technology called brain fork hair.
    28. 00:01:34
      One of the really exciting things about
    29. 00:01:36
      this, and a pearl to me, is that this
    30. 00:01:38
      goal actually pulsates. This is news to
    31. 00:01:41
      me.
    32. 00:01:43
      And so this new technology is looking at
    33. 00:01:46
      how does skull pulsability replicate the
    34. 00:01:49
      ICP waveform? And can we use this as a
    35. 00:01:52
      surrogate marker for intracranial
    36. 00:01:54
      compliance? And so they've done a lot
    37. 00:01:57
      of really interesting work and sort of
    38. 00:01:59
      automating cloud performances to look at
    39. 00:02:02
      the waveform analysis and to extract
    40. 00:02:05
      sort of the slope of the PA2P1 ratio,
    41. 00:02:10
      time to peak. Again, all of these
    42. 00:02:12
      physiologic parameters that we can see
    43. 00:02:14
      in our waveform, they've actually used
    44. 00:02:17
      some AI computing better understand how
    45. 00:02:22
      we can use this sort of novel
    46. 00:02:26
      application that really relies on the
    47. 00:02:29
      like micro millimeter changes in school
    48. 00:02:31
      pulsation. Really fascinating stuff.
    49. 00:02:35
      Dr. Pusho looked at, you know, from a
    50. 00:02:39
      team perspective, how they are applying
    51. 00:02:41
      cranial synthesis technology. So
    52. 00:02:43
      cranial synthesis is another
    53. 00:02:44
      non-invasive ICP monitor. It's a little
    54. 00:02:47
      patch that goes on the forehead and then
    55. 00:02:49
      there are two clips that go on the body
    56. 00:02:52
      looking again at the vascular changes
    57. 00:02:54
      under pressure to provide a non-invasive
    58. 00:02:57
      measurement of ICP. And so again, she
    59. 00:02:59
      really talks about the team-based
    60. 00:03:01
      approach and how this is, you know,
    61. 00:03:04
      feasible to do with the bedside, which
    62. 00:03:05
      is important. And Dr. Hazala discusses
    63. 00:03:08
      his project using a neural network to
    64. 00:03:14
      automate
    65. 00:03:16
      ultrasonographic measurements of the
    66. 00:03:18
      optic nursery diameter. So again, this
    67. 00:03:21
      is how can we automate something that we
    68. 00:03:23
      know already can be used to approximate
    69. 00:03:27
      intracranial pressure. And part of this,
    70. 00:03:30
      I think, was really interesting is that
    71. 00:03:32
      we really needed to develop a better
    72. 00:03:34
      standardization of how to measure optic
    73. 00:03:36
      nerve teeth diameter. And so part of
    74. 00:03:38
      his project is looking at sort of an
    75. 00:03:41
      international effort to standardize that
    76. 00:03:43
      optic nerve teeth diameter measurement
    77. 00:03:45
      And then applying sort of machine
    78. 00:03:49
      learning and automated ultrasonic
    79. 00:03:51
      graphic measurements
    80. 00:03:54
      of the optic nerve teeth diameter. So
    81. 00:03:56
      this was really, really fascinating
    82. 00:03:58
      sort of cutting edge research that I
    83. 00:04:00
      think will move our field forward. So
    84. 00:04:03
      one of the most exciting things that was
    85. 00:04:05
      discussed today was the impact of
    86. 00:04:08
      regional normal thermic perfusion and
    87. 00:04:11
      should this be the future of organ
    88. 00:04:13
      donation So normal thermic regional
    89. 00:04:16
      perfusion is insight to resuscitation of
    90. 00:04:20
      a donor. with extracorporeal support.
    91. 00:04:22
      So again, the patient is a patient that
    92. 00:04:24
      undergoes DCD, so donation after
    93. 00:04:27
      circulatory death. And the problem with
    94. 00:04:30
      DCD is that there are double the amounts
    95. 00:04:32
      of discarded organs, right? And our
    96. 00:04:35
      goal when we are taking someone to DCD
    97. 00:04:37
      is that we optimize the number of organs
    98. 00:04:39
      that we are able to give to save other
    99. 00:04:41
      lives. And this is important because
    100. 00:04:44
      DCD is becoming an increasingly common
    101. 00:04:47
      way that
    102. 00:04:49
      organ donation is that organs are
    103. 00:04:52
      procured. And so this session is about
    104. 00:04:55
      the ethical implications of using
    105. 00:04:57
      mechanical circulatory support. And
    106. 00:04:59
      even the patient's own heart to improve
    107. 00:05:01
      profusion to better understand which
    108. 00:05:05
      organs are going to be viable so that we
    109. 00:05:07
      are not transplanting bad organs. So
    110. 00:05:10
      it's to improve the number of eligible
    111. 00:05:13
      organs for transplantation and the
    112. 00:05:17
      quality of those organs And so Dr.
    113. 00:05:20
      Durant, who starts this session off,
    114. 00:05:22
      does a fantastic job of walking the
    115. 00:05:24
      audience through the variations of
    116. 00:05:26
      normal thermic, regional perfusion,
    117. 00:05:28
      and how these intersect with the ethical
    118. 00:05:30
      principles of autonomy, beneficence,
    119. 00:05:32
      non-maleficence, and justice. And
    120. 00:05:35
      then there is a pro-contubate, which I
    121. 00:05:37
      will not spoil, but really interesting,
    122. 00:05:40
      fascinating stuff to check out. And so
    123. 00:05:42
      I really urge anyone who can catch it on
    124. 00:05:44
      demand to check out that session. That
    125. 00:05:47
      is it for today It's been a fantastic
    126. 00:05:49
      meeting. I'm so glad to have gotten to
    127. 00:05:51
      join to give sort of a recap of some of
    128. 00:05:54
      the most exciting sessions. And I hope
    129. 00:05:55
      that you'll check them out.

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