Critical Matters

Acute Pulmonary Embolism: Clinical Guideline Update

In this episode Dr. Sergio Zanotti discusses the recently released Clinical Practice Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults. This guideline is a report of the American College of Cardiology / American Heart Association Joint Committee on Clinical Practice Guidelines. He is joined by Dr. Mark Creager, the lead author and chair of the writing committee for these guidelines. Dr. Creager is Professor of Medicine and Professor of Surgery at the Geisel School of Medicine at Dartmouth. A past president of the American Heart Association, he is an internationally recognized leader in vascular and cardiovascular medicine with more than 400 scientific publications. Additional resources: 2026 AHA/ACC/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults: A Report of the American College of Cardiology / American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2026: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001415 Surgical Management and Mechanical Circulatory Support in High-Risk Pulmonary Embolisms: Historical Context, Current Status, and Future Directions: A Scientific Statement From the American Heart Association. Circulation 2023: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001117 Antithrombotic Therapy for VTE Disease: Second Update of the CHEST Guideline and Expert Panel Report. CHEST 20: https://journal.chestnet.org/article/S0012-3692(21)01506-3/fulltext Books mentioned in this episode: Team of Rivals: The Political Genius of Abraham Lincoln. By Doris Kearns Goodwin: https://bit.ly/4skCS0c Alexander Hamilton. By Ron Chernow: https://bit.ly/4rFuxTw Vascular Medicine: A Companion to Braunwald’s Heart Disease. By Mark Creager et al.: https://bit.ly/4uHZ4Dc

ECMO Emergencies

In this episode, Dr. Sergio Zanotti discusses a structured approach to ECMO emergencies, focusing on recognizing cardiac arrest, organizing the team response, and early ECMO troubleshooting to support key life-saving interventions. He is joined by Dr. Waqas Akhtar, a consultant at Guy's & St Thomas' NHS Foundation Trustin the United Kingdom. Dr. Akhtar completed full postgraduate certification in Cardiology, Intensive Care & General Internal Medicine, with a particular interest in cardiogenic shock, heart transplantation, and mechanical circulatory support Additional resources: British societies guideline on the management of emergencies in patients on extracorporeal membrane oxygenation. Waqas Akhtar, et al. Intensive Care Med 2025: https://pubmed.ncbi.nlm.nih.gov/41051555/ UK multisociety consensus statement on the emergency and resuscitation of patients with left-sided Impella support. Waqas Akhtar, et al. BMJ Journals 2026: https://heart.bmj.com/content/early/2025/12/17/heartjnl-2025-326896 Books mentioned in this episode: His Dark Materials Series: The Golden Compass; The Subtle Knife; The Amber Spyglass: https://bit.ly/4cmSXgB

Acute Type B Aortic Dissection

In this episode of Critical Matters, Dr. Sergio Zanotti discusses the management of acute type B aortic dissection. He is joined by Dr. Firas Mussa, a vascular surgeon and professor at McGovern Medical School at UTHealth Houston. Dr. Mussa also holds a joint appointment with Imperial College in London. Additional resources: Management of Acute Type B Aortic Dissection. FF Mussa and P Kougias. N Engl J of Med 2025: https://pubmed.ncbi.nlm.nih.gov/40902163/ 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. EM Isselbacher, et al. Circulation 2022: https://pubmed.ncbi.nlm.nih.gov/36322642/ Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) Reporting Standards for Type B Aortic Dissections. JV Lombardi, et al. J Vasc Surg 2020: https://pubmed.ncbi.nlm.nih.gov/32001058/ Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial. INSTEAD-XL Trial. CA Nienaber, et al. Circ Cardiovasc Inter 2013: https://pubmed.ncbi.nlm.nih.gov/23922146/ Books mentioned in this episode: A Dangerous Liaison: A Revelatory New Biography of Simon de Beauvoir and Jean-Paul Satre. By Carole Seymour-Jones: https://bit.ly/3L0pIov A Time For All Things: The Life of Michael E. DeBakey. By Craig Miller, et al.: https://bit.ly/44B2uMw

PCT Reassessed

In this episode, Dr. Zanotti discusses the role of Procalcitonin in the ICU. He is joined by Dr. Simran Gupta, an infectious disease specialist at Brigham & Women's Hospital in Boston. Dr. Gupta has additional training in Clinical Research, Transplant, and Infectious Disease. She recently published an article on reassessing the role of Procalcitonin in critically ill patients with sepsis. Additional resources: Reassessing Procalcitonin-Guided Antibiotic Therapy in Critically Ill Patients with Sepsis: Lessons from the ADAPT-Sepsis Trial. S. Gupta, et al. Clinical Infectious Disease 2025: https://pubmed.ncbi.nlm.nih.gov/40579227/ Biomarker-Guided Antibiotic Duration for Hospitalized Patients With Suspected Sepsis: The ADAPT-Sepsis Randomized Clinical Trial. JAMA 2025: https://pubmed.ncbi.nlm.nih.gov/39652885/ Procalcitonin-guided antibiotic therapy may shorten the length of treatment and may improve survival- a systematic review and meta-analysis. M Papp, et al. Crit Care 2023: https://pubmed.ncbi.nlm.nih.gov/37833778/ Books and entertainment mentioned in this episode: Shantaram: A Novel. By Gregory David Roberts: https://bit.ly/4ovVHKX SHANTARAM – Apple TV series: https://tv.apple.com/us/show/shantaram/umc.cmc.atxsrive40xli3zh3uxjimut

Capillary Refill Time (CRT)

In this episode, Dr. Sergio Zanotti discusses the assessment of peripheral perfusion as a tool to guide treatment in septic shock. Specifically, he dives into Capillary Refill Time. He is joined by Dr. Eduardo Kattan, a critical care and anesthesia physician. Dr. Kattan is an Assistant Professor at the Pontificia Catholic University of Chile, where he also serves as Adult Critical Care Program Director and Director of Research and Academics in the Department of Critical Care Medicine. A prolific investigator, he focuses his research on septic shock and medical education. Dr. Rattan is the Co-Principal Investigator of the recently published ANDROMEDA-SHOCK 2 clinical trial. Additional resources: Personalized Hemodynamic Resuscitation Targeting Capillary Refill Time in Early Septic Shock. The ANDORMEDA-SHOCK-2 Randomized Clinical Trial. JAMA 2025: https://jamanetwork.com/journals/jama/fullarticle/2840823 Effect of Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on. 28-Day Mortality Among Patients With Septic Shock. The ANDROMEDA-SHOCK Randomized Clinical Trial. JAMA 2019: https://jamanetwork.com/journals/jama/fullarticle/2724361 Perspectives on peripheral perfusion assessment. Eduardo Kattan, et al. Curr Opin Crit Care 2023: https://pubmed.ncbi.nlm.nih.gov/37078639/ Books mentioned in this episode: The Little Prince. By Antoine de Saint-Exupery: https://bit.ly/49YcSRJ The Autumn Ghost: How the Battle Against a Polio Epidemic Revolutionized Modern Medical Care. By Hannah Wunsch: https://bit.ly/4i9PiUf