🧵 Long-term outcomes after #ECMO are lacking in the literature. A brief thread on our new paper in @JAMA_current, looking at mental health outcomes in survivors after ECMO (OPEN ACCESS). Thrilled to have presented the results live @ESICM #LIVES2022 jamanetwork.com/journals/jam…

#ICYMI: Long-Term Risk of Stroke After TIA or Minor Stroke @FaizanK91 @HotchkissBrain @UCalgaryMed @mihill68 @VYogendrakumar @draravindganesh @SimonFaHo @shanfernands @khanevski @rondalun1

The mic cut out during O Canada, and the Buffalo crowd didn’t miss a beat 🇨🇦

💙 Methylene blue in septic shock: miracle, myth… or misunderstood tool? We all know the scenario: 👉 Refractory vasoplegic shock 👉 Escalating norepinephrine 👉 Vasopressin, steroids… still hypotensive At some point, the question comes: Should we use methylene blue? ⚡ Mechanism Septic shock = NO-driven vasoplegia Methylene blue acts by: ❌ Inhibiting nitric oxide synthase (NOS) ❌ Blocking soluble guanylate cyclase ⬇️ Reducing cGMP ➡️ Restoring vascular tone 👉 A true catecholamine-sparing strategy 📊 What does the evidence say? Reality check: Use in practice is rare (~0.5% of septic shock patients) Often used as late salvage therapy Dosing strategies = highly variable But RCT signals are interesting: ↓ Vasopressor duration ↓ ICU / hospital length of stay Possible ↓ mortality (low certainty) 👉 Evidence is promising… but still weak 🚨 The clinical dilemma Timing is everything: Early use → potential physiologic benefit Late use → often too late to change trajectory 👉 Current practice is probably backwards ⚠️ What about safety? Potential concerns: Serotonin syndrome (with SSRIs) Pulmonary vasoconstriction G6PD-related hemolysis Interference with pulse oximetry 👉 Most serious effects seen with high doses 🧠 Take-home message > Methylene blue is not a “magic drug” but it may be a physiology-driven adjunct in vasoplegic shock ❓The real questions are: Who benefits? When to give it? At what dose? 🚀 Where we’re heading Ongoing trials (e.g., BLUSH trial) will clarify: ✔️ Early vs late use ✔️ Optimal dosing strategy ✔️ True impact on mortality 👉 This could redefine vasoplegic shock management 💡 Clinical reflection Next time you face refractory shock, ask: 👉 Is this still “fluid catecholamine problem”… 👉 or already a NO-mediated vasoplegia problem? 📚 Reference Fernando, S. M.et al. Journal of Critical Care, 92, 155353. doi.org/10.1016/j.jcrc.2025.…

⚙️ Curious re the long term outcomes of ECMO & iMV? 🫁 👀 Check out N Jawa & @shanfernands’s new 🌟editorial🌟 on L Rose et al’s study in #journal_CHESTCritCare: Ed: chestcc.org/article/S2949-78… Art: chestcc.org/article/S2949-78…

We're expanding our group! If you want to work with an amazing team in a terrific city, please consider applying! Please share widely. canadiancriticalcare.org/Job…

A devastating loss. A brilliant clinician-scientist, and a genuinely amazing human being. I have no words.

Another output from superstar fellow @JungRichardG - Prognostic factors associated with mortality in septic shock: a systematic review and meta-analysis - out in @LancetRespirMed Downloadable: authors.elsevier.com/a/1mWi%… Kudos to @SameerKadri12 for the accompanying editorial. In fields like cardiogenic (evidence.nejm.org/doi/full/1…) and septic shock we generate large amounts of prognostic data that live individually in studies published across time, journals etc. These findings have important implications for clinical and research applications but it can be difficult to understand these factors comparatively. In our publication, we boiled the data down to 95 eligible studies that included 4.8 million eligible patients. We divided the analysis into patient, presentation factors and biochemical markers as they related to in-hospital or 30-d mortality. Significant patient factors included black race, history of cirrhosis or malignancy. Significant presentation risk factors included respiratory source, AKD or elevated risk score (SOFA>APACHE>SAPSII) Significant treatment/biochemical risk factors included need for NE or mechanical ventilation. The identification of these prognostic factors could aid in clinical risk application, goals of care discussions, and identifying the subset of patients at highest and lowest risk of early mortality for patients with septic shock. Kudos to co-authors and collaborators @shanfernands @rebeccamathewmd @Bram_Rochwerg @PietroDiSantoMD @PietroDiSantoMD @GProsperiPorta @cameron_stotts #SEPSIS #SpesisAwareness #StopSepsis #critcare #criticalcare #ICU #CICU @MayoClinicCV @mayoclinicCCM @MayoPCCM @MayoCCJC @UOHI

Kudos to the author team including lead author @shanfernands from our @LakeridgeHealth @queensccm Critical Care faculty! Looking forward to the eventual results of the BLUSH trial underway to provide the randomized evidence needed to evaluate methylene blue in septic shock.

🔍 Methylene blue (MB) use is uncommon in septic shock, with substantial variability across time, patient populations, and hospitals. Randomized evidence is required to evaluate the efficacy and safety of MB. 📖 Read more in CCM: ow.ly/YoTN50Y432S #CritCareMed #SCCM @SCCM

Proud that @LakeridgeHealth has recruited its first patient into the @AlterAKItrial! An RCT designed to test the efficacy of albumin infusion during dialysis in critically ill adults. We are excited to contribute to this important RCT! @edclark75 @CCCTG_ @cmcpher @drrandywax

We just published in @ResusJournal a meta-analysis of MCS after ROSC While only 1 RCT addressed this topic only in CA pts, most RCTs of MCS in AMI-CS enrolled a high proportion of post-CA pts We pooled data from RCTs with available CA subgroups. sciencedirect.com/science/ar… 1/

"I'm stunned that we're standing here talking about the Blue Jays winning the [AL] East." #MLBTonight reacts to Toronto's division clinch.

🚨📣 A long-awaited study from my #BantingCanada fellowship examining predictors of recurrent #VTE and anticoagulant-related🩸 #bleeding in patients with cancer was published in #EHJ today to coincide with my live presentation at #ISTH2025‼️ academic.oup.com/eurheartj/a…

🩸 Meta-analysis presented at #ISTH2025 and simultaneously published in @ehj_ed found that several risk factors (e.g., previous history of VTE or bleeding, advanced cancer, and specific cancer sites) are associated with recurrent VTE and bleeding in patients with CAT. academic.oup.com/eurheartj/a…

Speaker Spotlight! @tomrollinsonPT @shanfernands and Heather O'Grady will be speaking at the 17th World Congress of Intensive and Critical Care! wcicc2025.com/registration #CCCS #WFICC #CSRT #CACCN

Huge congratulations to our very own Dr. Sibley for receiving a @CIHR_IRSC project grant to study magnesium prophylaxis to prevent atrial fibrillation in critically ill patients.

People will inevitably tell you that their favorite inodilator (usually milrinone) is better since there are fewer arrhythmias compared to the other (usually dobut) DOREMI says 🤷‍♂️

⭐ The ILCOR has published its latest Consensus on Science with Treatment Recommendations (CoSTR), outlining vital updates in resuscitation science and post-cardiac arrest care. See our website for the full media release: 👉 ilcor.org/news/ilcor-consens… #ILCOR #Resuscitation #Science

Sharing what we hope is an important paper in #SHOCK out today in @NEJMEvidence by @JungRichardG (who just matched to cardiology!). Prognostic Factors Associated with Mortality in Cardiogenic Shock — A Systematic Review and Meta-Analysis | NEJM Evidence evidence.nejm.org/doi/full/1…

Deborah Cook, professor @MacDeptMed, has been announced as a 2025 laureate of the @CdnMedHallFame. @MacCriticalCare @StJoesHamilton ow.ly/vwzN50TCkJv