On this episode of Advances in Care, Erin Welsh is joined by Dr. Cara Agerstrand, director of the Medical ECMO Program at NewYork-Presbyterian and Columbia, and Dr. Matthew Baldwin, critical care specialist at NewYork-Presbyterian and research lead of Columbia’s Baldwin Lab which focuses on the study of critical illness survivorship. 

Thousands of people suffer from cardiopulmonary conditions such as cardiac arrest and severe respiratory illnesses in the United States every year, with many requiring mechanical ventilation and critical care in the ICU. To better serve these patients, NewYork-Presbyterian and Columbia has built a renowned program to manage these patients on rescue therapies like extra-corporeal membrane oxygenation (ECMO), the most advanced form of cardiopulmonary life support. Since 2009, the team at NewYork-Presbyterian and Columbia has established an expertise to care for the sickest respiratory and cardiac failure patients with this technology, and has been at the forefront of utilization which has rapidly evolved from early pediatric use to post H1N1 and COVID surges. 

The standards of care for ECMO treatment and patient outcomes set by New York Presbyterian and Columbia over the past decade has earned them recognition as an ELSO Platinum Level Center of Excellence, one of only a few centers worldwide to have consistently achieved this status since it was first awarded. The team takes this expertise further through advanced research in The Baldwin Lab, which focuses on a variety of projects to better understand the biological factors of why some patients fully recover from ICU stays and others do not, as well as physical, mental, and emotional wellbeing for patients.

Chapters:

[00:00 - 4:07] ECMO and Post-Intensive Care Syndrome 

Dr. Agerstrand describes advances in ECMO care and Dr. Baldwin outlines his research in post-intensive care syndrome and targeted recovery efforts. 

[4:07 - 9:25] Refining ECMO

Dr. Agerstrand discusses how Columbia’s early ECMO adoption positioned them to refine techniques and set a new standard for its use in the ICU. 

[9:25 - 14:33] Recovery After Prolonged Critical Care

Dr. Baldwin explains the pressing need for continued care for patients discharged after receiving prolonged critical care, and his research connecting ongoing inflammation with slowed recovery. 

[14:33 - 19:01] Advancing Post-ICU Care 

Dr. Baldwin shares how his team has identified a hyper-inflammation biomarker with implications for post-ICU care and beyond. Dr. Agerstrand reflects on the rewarding aspects of an often challenging field. 

[19:01 - 19:41] Credits

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Dr. Cara Agerstrand is an Associate Professor of Medicine and Director of the Medical ECMO Program at Columbia University Irving Medical Center / NewYork-Presbyterian Hospital. Dr. Agerstrand completed her Internal Medicine residency and Pulmonary & Critical Care fellowship at Columbia University Irving Medical Center. She is an elected member of the Steering Committee of the Extracorporeal Life Support Organization, a member of the ECMO and Mechanical Circulatory Support Domain Task Force of the American College of Chest Physicians and is extensively involved in clinical care, research, and educational efforts involving extracorporeal membrane oxygenation (ECMO) and extracorporeal carbon dioxide removal (ECCO2R). She has special interests in the use of ECMO for severe forms of the acute respiratory distress syndrome (ARDS), pulmonary hypertension and in pregnant and postpartum patients. Dr. Agerstrand is widely published and is an internationally invited speaker.

Dr. Matthew Baldwin, MD, MS, is a board-certified pulmonary and critical care physician and clinical investigator with a Masters in Biostatistics. Dr. Baldwin’s laboratory aims to improve critical illness survivorship. His research into survivors of acute respiratory failure works to elucidate the mechanisms of post-ICU frailty as therapeutic targets for improving physical recovery. He has identified frailty subtypes in acute respiratory failure survivors, and discovered that aging-related plasma biomarkers of inflammation, neuro-endocrinopathy, and muscle mitochondrial myopathy are potential therapeutic targets for post-ICU interventions. His research related to palliative care aims to improve ICU survivorship, and he has developed novel palliative care interventions for mechanical ventilation patients, such as chaplain-led communication-board-guided spiritual care.

For more information visit nyp.org/Advances