The Daily Dose • Saturday, May 15, 2021

Celebrating Advances in Anesthesia and Critical Care at All Career Stages

Shari Fisher Hinds, RN, MSN, FNP

The “Lifetime Achievement Award and Young Investigator Award Session,” at the SOCCA 2021 Annual Meeting on May 14, provided a moment to celebrate the inspiring work being done in the fields of anesthesia and critical care, with presentations from an established leader in the field and three up-and-coming early-career researchers.

Becoming A Leader in the Field: Contributions to the Critical Care Community

This year’s the SOCCA Lifetime Achievement Award was awarded to Jeanine P. Wiener Kronish, MD, Henry Isaiah Dorr Distinguished Professor of Research and Teaching in Anaesthetics and Anaesthesia and former Anesthesia in Chief at Massachusetts General Hospital. Moderated by Robert Stevens, MD, FCCM, of John Hopkins University, with an introduction from Meghan Lane-Fall, MD, MSHP, FCCM, of the University of Pennsylvania, the session honored Dr. Wiener-Kronish’s work, her leadership and contributions to the field of critical care. The SOCCA Lifetime Achievement Award is the most prestigious award given by the organization and honors an individual who most represents exemplary professional practice and leadership in the critical care community.

During the presentation, Dr. Wiener-Kronish’s journey of becoming a leader in her field was explored. Dr. Wiener-Kronish first obtained her BA at UCLA before continuing to UCSF to study medicine at the young age of 20. She taught at both UCSF and Harvard School of Medicine, and, most recently, worked as Anesthesia in Chief at Massachusetts General Hospital from 2008-2019. She has published her work in numerous medical journals, written numerous peer reviews, and authored several books. She has been the prior recipient of the American Thoracic Society Lifetime Achievement Award. Her research has focused on acute lung injury caused by Pseudomonas Aeruginosa in ICU patients, and beneficial bacterial colonization in patients with asthma, cystic fibrosis and the critically ill.

In Dr. Wiener-Kronish’s presentation, she discussed her accidental path to becoming an intensivist after being denied an opportunity to work in pulmonology. This changed her course, where she began her rotation in anesthesia and led her to focus on research, which was a criteria to becoming a specialist in internal medicine. Research proved helpful to her, allowing her to have a more flexible schedule so that she could focus on raising her family as well as her career. She also believes that research provides a path for improved patient care and can also be a great option for those who need a less physically demanding role in medicine. By running her own lab for over 30 years, she was able to work with many medical students from all over the world. These interactions built a huge network within the medical community and provided the foundation for her successful career.

She went on to discuss her thoughts on COVID-19 and how it is providing incredible opportunities for advancements in medicine and anesthesia. One growing problem is morbid obesity in the patient population and which leads to abnormal pulmonary physiology and higher risk of acute respiratory distress syndrome (ARDS). The use of electronic impedance tomography (EIT) allows for more personalized PEEP settings and can be very good at preventing ARDS. Additionally, the levels of sedation and narcotic use in hospitals has spiked due to the COVID-19 outbreak, more than she has seen used in the last 40 years of practice. This has highlighted the need to observe electroencephalograms (EEGs) more closely so that sedation can be more closely titrated. Data has shown that increased sedation leads to increased mortality and coma. Also, increased use of opioids leads to delirium in COVID-19 patients, and long-term outcomes are unknown. Use of EEGs in the OR and ICU can prevent burst suppression patterns that lead to poor outcomes. Many COVID-19-related studies are just being written, so she is optimistic that there will be much more data to come to help advance the care of the critical care patient. 

Young Investigators Advancing Science

Additionally, the 2021 Young Investigator Award went to Kasey Grewe, MD, a critical care fellow at UCLA, for her research on “Peripartum ECMO for COVID-19.” She presented several cases describing her team’s experiences with extracorporeal membrane oxygenation (ECMO) for pregnant and postpartum women with COVID-19 ARDS, supporting 43 such patients at her center. Eight of these cases were in pregnant and postpartum women. She has found that the rate of survival for these patients was higher than all other peripartum patients at her center (86% vs 57%), leading to improved maternal and fetal outcomes. During the presentation, she reviewed seven of these cases, including unique characteristics of each case, and described the considerations for care that proved helpful. In the first three cases, all neonates required intubation but ultimately survived. Two patients experienced massive postpartum bleeding and one experienced a pulmonary embolism despite therapeutic coagulation, highlighting the complex interplay between bleeding risk and hypercoagulability in this population. They also treated four postpartum women. Pointing out the clinical interest from these cases, three of the patients suffered clinical decompensation on postpartums days 1 and 2, suggesting a common physiologic mechanism (e.g., autotransfusion following delivery). A major takeaway from the study was that ECMO provides a relatively safe and effective way to maintain maternal oxygenation and ventilation while maintaining lung protective ventilation. As a final point, she also mentioned that pregnant women with COVID-19 ARDS should receive steroids to speed fetal lung maturity because these patients are at higher risk for preterm labor. Dr. Stevens commended Dr. Grewes for her work as being on the cutting-edge of technology and physiology.

The 1st runner up for the Young Investigator Award went to Santiago J. Miyara, MD, from Elmezzi Graduate School of Molecular Medicine, Feinstein Institutes for Medical Research for his abstract, “The Neuroprotective Effects of Metformin: Insights from Rodent Cardiac Arrest and In Vitro Ischemia-Reperfusion of Neurons and Astrocytes.” Dr. Miyara presented his findings. Brain damage due to ischemia and repercussion injury is an important challenge in postcardiac syndrome. Although metformin’s mechanism of function are still under investigation, compelling evidence has shown the diversity of these mechanisms, which include modulation of oxidative stress and cell death in self-phenotype dependent fashion, he explained. In his study, they examined the effects of metformin on a rodent of cardiopulmonary arrest, exploring the effects of metformin in vitro on single cultures of astrocytes and neurons. The in vivo model of cardiac arrest shows that metformin treatment improves survival trend at 72 hours from 43.8% to 68.8%. Metformin also significantly improved neurological function at 72 hours. The metformin group showed significantly better cellular integrity. The overall conclusion from the study was that metformin improves survival and cell viability outcomes in both in vivo and in vitro models and demonstrated increased neurological function and improved brain psychologic morphology as well as decreased ROSC production in the rodent cardiac arrest model.

The 2nd runner up for this award was Ashish K. Khanna, MD, FCCP, FCCM, from Wake Forest University School of Medicine, who discussed his research, “Cardiac Output Estimation by Multi-Beat Analysis of Arterial Blood Pressure Waveform versus Continuous Pulmonary Artery Thermodilution in Post Cardiac Surgery Intensive Care Unit Patients.” He discussed how mean arterial pressure is associated with outcomes especially in critically ill patients. However, blood pressure is not the full story, Dr. Khanna explained, and that cardiac output monitoring is critical for establishing an appropriate flow pressure relationship. Using a prospective, observational cohort of postcardiac surgery patients in the ICU, he used a long-term interval (LTI) analysis of arterial blood pressure, a novel method to estimate cardiac output using as arterial line and a pressure transducer with analysis. One hundred patients were enrolled in the study. Dr. Khanna presented the results from 24 of those patients. The research uncovered 1012 paired measurements across the 24 patients. Overall conclusion from the study was that cardiac output measurements using a novel analysis of arterial blood pressure waveform are moderately correlated with the traditional, more invasive pulmonary artery thermodilution-guided cardiac output measurement which agree with previous validation of the arterial blood pressure waveform method.

To learn more about their research, view their ePosters at https://epostersonline.com/am2021.

Encourage, stimulate, and fund ongoing anesthesia-related research projects that will enhance and advance the specialty, and to disseminate current, state-of-the-art, basic and clinical research data in all areas of clinical anesthesia, including perioperative medicine, critical care, and pain management. The IARS is focused solely on the advancement and support of education and scientific research related to anesthesiology.

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IMRA Awards

This award is intended to support investigations that will further the understanding of clinical practice in anesthesiology and related sciences. Up to four research projects are selected annually, with a maximum award of $175,000 each, payable over two years.

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