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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.