SoCCC Pre-Rounds: Bite-Sized Critical Care Cardiology Topics Delivered By Experts

In this episode of SoCCC Pre-Rounds, Dr. Simon Parlow is joined by Dr. Hatem Soliman, a leading expert in critical care echocardiography, for a deep dive into the game-changing role of point-of-care ultrasound or POCUS in resuscitation and cardiac intensive care.Together, they unpack how resuscitative echocardiography can help identify reversible causes of cardiac arrest, like pericardial tamponade or tension pneumothorax, and even guide real-time chest compression placement to improve CPR effectiveness.Dr. Soliman highlights two must-have views: the apical five-chamber for stroke volume and the short-axis great vessels view to assess RV function and pulmonary pressures.If you're looking to sharpen your bedside skills and bring more precision to your resuscitation toolkit, this episode is packed with insights you won’t want to miss.Key TakeawaysMove beyond the IVC: Hepatic, portal, and renal vein Doppler give a clearer picture of systemic venous congestion than IVC alone.Cardiac output needs context: Doppler VTI can mislead unless combined with views like apical five-chamber and timing indices like isovolumetric contraction time.Every echo parameter has a pitfall: Never interpret one measure in isolation; always integrate findings with clinical judgment.His go-to views in shock? Apical 5 chamber (LVOT VTI) and parasternal short axis of great vessels (PA flow) to assess perfusion and RV afterload.In This Episode[00:00] Introduction to the podcast[02:24] Role of echo in cardiac arrest[03:43] Training and cautions with echo in CPR[06:19] Key skills for new trainees in critical care echo[07:33] Physiological assessment in critical care echo[09:21] Multi-organ ultrasound and venous congestion[11:45] Systemic venous congestion in post-ICU patients[12:18] Comprehensive cardiac output assessment[15:50] Pitfalls and dangers of critical care POCUS[17:18] Favorite echo views in cardiac ICUNotable Quotes[06:33] "Critical care echo is actually complex... you need to further proceed from this basic level to intermediate and then advanced levels in which you will be able to assess physiological changes in the heart." — Dr. Hatem Soliman[09:22] "The practice of multi-organ ultrasound and looking beyond the chest cavity for congestion is a very important advancement in point-of-care ultrasound." —Dr. Hatem Soliman[17:24] "If I have two views to look at in a very short time... the apical five chamber view to get the LVO TVTI because that immediately gives you a clue about stroke volume and cardiac output." — Dr. Hatem SolimanDr. Hatem SolimanDr. Hatem Soliman is a cardiac intensivist at Harefield Hospital and senior lecturer at King’s College London. He serves on the executive board of the European Association of Cardiovascular Imaging and the editorial board of JACC: Cardiovascular Imaging. A global educator and author of key POCUS textbooks, Dr. Suleiman is renowned for advancing the use of bedside echocardiography in critical care to improve hemodynamic assessment and patient outcomes.Resources and LinksBecome a member of the Community: https://www.soccc.org/subscribeDr. Hatem Solimanhttps://www.escardio.org/https://www.linkedin.com/in/hatemsoliman/Dr. Simon Parlowhttps://www.ottawaheart.ca/profile/parlow-simonMentioned Doyen A. et al. Portal Doppler Ultrasound in Congestion Assessment (André Denault’s work)JACC Imaging, Journal of Cardiovascular UltrasoundEuropean & American Resuscitation GuidelinesSupported By:This episode is made possible by unrestricted support from Zoll LifeVest — thanks for keeping high-impact education free for our community.DisclaimerThis podcast is not medical advice, just candid, practical discussions about what your hosts do every day in the CICU. Always consult your supervising team and current guidelines before applying any interventions.

Courtney Bennett, a critical care cardiologist and echocardiographer at Mayo Clinic Rochester, guides listeners through bedside recognition and management of cardiac tamponade. Short, clear sentences cover physical exam clues like tachycardia and pulsus paradoxus. She explains why rate of fluid accumulation matters, how point-of-care echo complements clinical judgment, and when urgent drainage and stabilization are needed.

Dr. Aniket Rali, a dual-trained heart failure and critical care cardiologist at Vanderbilt who teaches bedside hemodynamics, walks through pulmonary artery catheter fundamentals. He covers when to use PACs for unclear shock, who should avoid them, waveform recognition, leveling/zeroing and troubleshooting, and practical tips for safe placement and daily monitoring.

Dr. Rebecca Mathew, a leading critical care cardiologist at the University of Ottawa Heart Institute, shares her expertise on managing cardiogenic shock. She emphasizes the importance of history and physical exams over lab results for diagnosis. Initial aggressive diuresis is crucial, with inotropes only if hypoperfusion persists. Rebecca discusses ongoing trials and the use of Swan-Ganz catheters for monitoring, while stressing the need to avoid premature prognostications in the first 48 hours, ensuring a comprehensive approach to patient care.

Dr. Jason Bartos, an interventional and critical care cardiologist at the University of Minnesota, dives deep into extracorporeal cardiopulmonary resuscitation (ECPR). He discusses the critical timing for ECMO use during cardiac arrest and outlines essential patient selection criteria. Bartos shares insights from key studies like the ARREST trial and emphasizes the importance of high-volume centers. He highlights strategies for sedation and temperature management while underlining the nuances of neuroprognostication—urging patience when evaluating recovery.

Dr. Ryan Tedford, an expert in right ventricular failure and section chief of heart failure, shares his deep knowledge on a condition that often flies under the radar. He explains how to accurately diagnose RV failure through critical hemodynamic measures and why understanding the right heart is vital in severe illnesses. Tedford emphasizes the importance of fluid management and the role of pulmonary vasodilators and inotropes. He also discusses the right ventricle's surprising resilience and its potential for recovery with proper care.

What do you do when a patient returns from the cath lab hypotensive and unstable? In this episode of SoCCC Pre-Rounds, critical care cardiologists Dr. Ann Gage and Dr. Zach Il'Giovine join host Dr. Elliott Miller to break down the management of post-catheterization hypotensive emergencies. This conversation delves into rapid assessment, differential diagnosis, and life-saving interventions in the acute care setting.The experts emphasize the importance of taking a moment to gather context before rushing to the bedside. Was it a PCI, EP study, or structural intervention? This pause allows for a more focused differential diagnosis, covering complications such as vascular issues (groin hematoma, retroperitoneal bleed), cardiac tamponade, and acute stent thrombosis. A standout takeaway: manual pressure is your first-line tool for managing bleeding, and don’t hesitate to call the proceduralist early. They also highlight when to order a CT scan (pro-tip: non-contrast first) and the principles behind massive transfusion protocols.This episode offers actionable insights for handling hypotensive emergencies with confidence and precision. Key TakeawaysBuild a differential based on the cath details: arterial, venous, pericardial?Retroperitoneal bleed is high on the list for sudden post-cath hypertension.First move: Is the patient in extremis? If yes, act. If not, think.Groin pain or back pain? Start with pressure and basic labs.For massive bleeds: use balanced transfusions and proper IV access.Most important treatment for groin bleeds? Manual pressure.In This Episode[00:00] Introduction[00:56] Meet the guests: Dr. Ann Gage and Zach Il'Giovine[02:09] Gathering info before seeing post-cath patient[03:46] Building the differential diagnosis[08:13] Physical exam and bedside assessment[09:57] Hemodynamic assessment and initial workup[16:00] Massive hemorrhage and transfusion protocols[17:05] Procedural complications and communication[19:55] Manual pressure crucial for groin bleeds[21:11] Conclusion and take-home messagesNotable Quotes[04:06] "I was told once by a medicine resident that if you were a good resident, you would have two or three things on your differential, but if you were great, you would appear at the bedside with at least 10 things on your differential." — Dr. Ann[00:13:55] "Nothing really makes me madder than coming in the morning and seeing that the residents gave contrast to ten people, when if you've got a hemodynamically significant bleed, you do not need contrast." — Dr. Elliott[00:20:53] "On more than one occasion, manual pressure has saved lives." — Dr. Zach Dr. Ann GageDr. Ann Gage is a critical care and interventional cardiologist at Centennial Heart in Nashville. She bridges the cath lab and CICU with expertise in both patient care and procedural nuance.Dr. Zach Il'GiovineDr. Zach Il'Giovine is a heart failure and critical care cardiologist at Centennial Heart. He focuses on managing complex ICU patients, procedural complications, and bridging multidisciplinary care.Resources and LinksBecome a member of the Community: https://www.soccc.org/subscribeDr. Ann Gage https://centennialheart.com/https://www.linkedin.com/in/ann-gage-b7036831https://x.com/anngagemd?lang=enDr. Zach IlGiovinehttps://centennialheart.com/https://www.linkedin.com/in/zachary-il-giovinehttps://x.com/zilgiovinemd?lang=enDr. Elliott Millerhttps://x.com/ElliottMillerMDhttps://www.soccc.org/Supported By:This episode is made possible by unrestricted support from Zoll LifeVest — thanks for keeping high-impact education free for our community.DisclaimerThis podcast is not medical advice, just candid, practical discussions about what your hosts do every day in the CICU. Always consult your supervising team and current guidelines before applying any interventions.

Dive into the complexities of ECMO with Dr. Jason Katz, who simplifies the differences between VV and VA ECMO. Discover classic indications for VA ECMO in critical situations like cardiogenic shock. Learn about the importance of an exit strategy for patients and how to navigate the early days of ECMO care. Unravel the mystery of Harlequin syndrome and its management during treatment. Plus, get insights on left ventricular venting and unloading strategies to enhance patient outcomes.

Dr. Elliott Miller, an Assistant Professor at Yale School of Medicine and Medical Director of the Cardiac ICU, dives into the urgency of managing ventricular tachycardia (VT) storms. He clarifies the differences between polymorphic and monomorphic VT, emphasizing tailored treatment. The conversation covers the rapid assessment of patient stability, optimal use of first-line antiarrhythmics like procainamide, and advances such as stellate ganglion blocks. Listeners gain actionable strategies for intervention, underscoring the importance of addressing the underlying causes.

Hosted by members of the Society of Critical Care Cardiology (SoCCC) Pre-Rounds delivers bite-sized, high-yield episodes designed for medical students, residents, fellows, early-career cardiologists, allied health professionals and all enthusiasts of critical care cardiology  navigating the complexities of the field.With only 160 critical care cardiologists in the U.S., mentorship is limited. SoCCC Pre-Rounds fills the gap with expert insights, clinical pearls, and real-world guidance on topics like cardiogenic shock, ECMO, and resuscitation. In short bite sized episodes, top leaders in the field answer key clinical questions—perfect for pre-round prep, night shifts, or sharpening your skills.Listen in. Level up. Join the SoCCC community.