In this episode of the NCS Podcast Hot Topics series, host Eric Lawson, MD, speaks with Stephan Mayer, MD, about the FASTEST clinical trial and the decades-long effort to determine whether ultra-early hemostatic therapy can improve outcomes for patients with spontaneous intracerebral hemorrhage (ICH). Dr. Mayer shares how the idea of using recombinant factor VIIa in ICH first emerged and how earlier trials helped shape the questions researchers are asking today.

The conversation explores what FASTEST revealed about the relationship between treatment timing, hematoma expansion and functional outcomes — and why identifying the patients most likely to benefit remains so important. Dr. Mayer also discusses the role of the CTA spot sign, the risks that must be weighed with factor VIIa and how lessons from FASTEST are informing the next phase of research.

Drs. Lawson and Mayer also discuss where hemostatic therapy could fit within the Code ICH approach and how advances in imaging and radiomics may help clinicians recognize ongoing bleeding sooner and better target treatment.

The views expressed on the NCS Podcast are solely those of the host and guest and do not necessarily reflect the opinions or official positions of the Neurocritical Care Socie

In this episode of the NCS Podcast Hot Topic series, host Eric Lawson, MD, is joined by Mona Kumar, MD, of the University of Pennsylvania, Lori Kennedy, PhD, RN, ACNP-BC, of UC Davis Health, and Meghan Vallejo, PharmD, BCCCP, of Temple University Hospital: three members of the multidisciplinary panel behind the newly published "Treatment of Antithrombotic Associated Intracranial Hemorrhage in Adults: A Focused Guideline Update from the Neurocritical Care Society and Society of Critical Care Medicine."

The conversation opens with how this focused update differs from the society's 2016 guideline, including a narrower set of clinical questions and a considerably more rigorous review process built around systematic reviews, formal risk of bias tools and a diverse voting panel that included a patient representative. From there, Drs. Kumar, Kennedy and Vallejo talk through several of the panel's toughest calls, weighing where the evidence was strong enough to guide practice and where long standing bedside habits are still running ahead of the data.

The conversation then turns to where these recommendations fit into broader ICH care pathways, what still needs to be studied, and where the panel sees a role, and a limit, for AI in future guideline development. The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

In this episode of the NCS Podcast Hot Topics series, host Rich Choi, DO, welcomes back Andrew Webb, PharmD, to unpack "Effect of Desmopressin on Attaining Therapeutic Hypernatremia with Hypertonic Saline Continuous Infusion in Intracranial Hemorrhage," recently published in Neurocritical Care.

Desmopressin has become a familiar tool for blunting antiplatelet-associated bleeding in intracranial hemorrhage, but its vasopressin-receptor activity raises a concern. Does it work against efforts to raise sodium with hypertonic saline? Dr. Webb traces desmopressin's path from a 1970s antidiuretic drug for diabetes insipidus to a hemostatic agent borrowed from the hemophilia literature, then walks through its pharmacokinetics, typical hemostatic dosing and the relatively modest side-effect profile clinicians should watch for.

The conversation turns to a single-center retrospective study that paired a protocolized, TEG-guided desmopressin dose with a nurse-driven hypertonic saline sliding-scale infusion targeting a sodium goal of 150–155 mEq/L. Drs. Choi and Webb walk through how the study was designed and what it found, touching on sodium goal attainment, TEG changes, 3% saline volumes and thromboembolic risk. They also dig into the study's limitations, including its more conservative desmopressin dosing relative to practice at other centers, and agree a randomized trial is still needed to settle desmopressin's role in ICH management more broadly. For clinicians giving desmopressin alongside hypertonic saline, Dr. Webb offers a practical piece of advice worth tuning in for.

The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

In this episode of the NCS Podcast Currents series, host Lauren Koffman, DO, MS, FCCM, speaks with Tarek El Halabi, MD, who leads acute neurology services at the American University of Beirut Medical Center, about his Currents article, "Neurocritical Care in Lebanon: Progress Within Constraint."

El Halabi didn't build a neuro ICU from the ground up. He joined an already established mixed medical-surgical unit and worked to change it from within, winning over colleagues and standardizing care for the emergencies that arise most often, including stroke, status epilepticus and bleeds. He and Koffman talk through what that took, from identifying the right people to lead each effort to investing heavily in nursing and resident training. While technical skills can be learned relatively quickly, building a lasting culture takes much longer.

They also dig into what "resource-limited" really means in a country with highly trained physicians and advanced medicine. In Lebanon, El Halabi explains, the constraint isn't expertise, but financial access and consistency, since a patient's care can depend heavily on their insurance and where they happen to present. He describes how his team redesigned stroke workflows to meet AHA/ASA benchmarks despite these limits, as well as where the program goes from here, including adding more faculty, developing a neuro ICU fellowship, strengthening research ties with NCS's MENA region colleagues, and eventually expanding telemedicine outreach beyond Beirut.

To read the full article, visit NCS Currents.

The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

In this bonus episode of the NCS Podcast Hot Topics series, host Rich Choi, MD, continues his conversation with Andrew Webb, PharmD, with a preview of "Subarachnoid Hemorrhage: Clazosentan vs. Fasudil for Vasospasm Prevention (SAVIOR) Study: Study Protocol for a Prospective, Multicenter, Randomized Trial," published in Neurocritical Care.

They review the history of nimodipine as the standard treatment for improving outcomes after aneurysmal subarachnoid hemorrhage and compare its mechanism with those of fasudil and clazosentan. Dr. Webb explains why fasudil is commonly used for vasospasm prevention in Japan and discusses previous research showing that clazosentan can reduce vasospasm without consistently improving functional outcomes when added to nimodipine.

The conversation also explores how the SAVIOR trial will directly compare clazosentan and fasudil in a nimodipine-free population. They consider whether the trial could establish a preferred approach in Japan, what its results might mean for practice elsewhere and whether clazosentan may eventually have a role for selected patients who cannot tolerate nimodipine.

The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

In this episode of the NCS Podcast Hot Topics series, host Rich Choi, DO, is joined by Andrew Webb, PharmD, to discuss the article "Valproic Acid for the Management of Agitation in Neurosurgical Intensive Care Unit Patients," published in Neurocritical Care.

Their conversation examines the complex causes of delirium and agitation in the neurocritical care setting, including neurologic injury, medication effects, sleep disruption and frequent clinical interventions. They review nonpharmacologic approaches to delirium prevention, current sedation strategies and the potential role of valproic acid as an adjunct when agitation remains difficult to control.

They also discuss findings from the retrospective study, in which valproic acid use was associated with reduced requirements for opioids, benzodiazepines and dexmedetomidine, along with fewer positive agitation scores and less use of physical restraints. Dr. Webb reviews the medication's multimodal effects, potential adverse events and drug interactions, and patient populations that may benefit from its use. He also emphasizes the need for careful monitoring, eventual deprescribing and prospective research to clarify valproic acid's role in neurocritical care.

The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

In this episode of the NCS Podcast Hot Topics series, host Eric Lawson, MD, speaks with NCS Vice President and Annual Meeting Planning Committee Chair Lori Shutter, MD, FNCS, for a preview of the NCS 24th Annual Meeting, taking place Oct. 20-23 in Seattle. Dr. Shutter discusses this year's theme, "Reaching New Heights: Advancing the Future of Neurocritical Care," and how it reflects the Society's continued growth and optimism about the future of the field.

The conversation offers a look at expanded workshop offerings, including sessions on the essentials of neurocritical care, critical care procedures, point-of-care and neurofocused ultrasound, and informatics and big data. Dr. Shutter also previews keynote addresses from Walter Koroshetz, MD, and Lisa Meeks, PhD, along with sessions focused on clinical trials, physiology, pediatric neurocritical care, global health, professional development and sustainability in the ICU.

Listeners will also learn about opportunities for first-time attendees and new members, the return of the leadership closing panel and an open brainstorming session focused on the Society's next major area of research. Dr. Shutter shares how attendee feedback shaped this year's program and offers advice for making the most of the meeting's concurrent sessions, networking opportunities and special events.

The views expressed on the NCS Podcast are solely those of the host and guest and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

In this episode of the NCS Podcast Perspectives series, host Nicholas Morris, MD, speaks with Jonathan Rosand, MD, MSc, FNCS, about his career in neurocritical care and his work to advance brain health. Dr. Rosand reflects on the mentors and bedside experiences that drew him to the field, as well as the curiosity and collaboration that have shaped his work as a neurointensivist, stroke geneticist and leader.

The conversation covers the growth of multidisciplinary care at Massachusetts General Hospital and the emotional demands of working in the neuroICU. Dr. Rosand discusses the importance of understanding patients' lives after critical illness and the potential for the neuroICU to serve as a starting point for long-term disease prevention and health promotion.

Drawing on his work in brain health, Dr. Rosand describes the Recovering Together program, the Brain Care Score and the Global Brain Care Coalition, along with the role of blood pressure control, lifestyle changes and patient agency in supporting long-term brain health. He also shares advice on mentorship, clinician-scientist careers and finding an individual path toward making meaningful contributions to the field.

The views expressed on the NCS Podcast are solely those of the host and guest and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

In this episode of the NCS Podcast Hot Topics series, host Rich Choi, MD, is joined by Chiara Robba, MD, PhD, to discuss the article "The Effects of Milrinone Systemic Administration on Cerebral Perfusion as Measured with Computed Tomography in Aneurysmal Subarachnoid Hemorrhage Patients," published in Neurocritical Care.

Their conversation explores the complex, multifactorial pathophysiology of delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage and the potential role of intravenous milrinone as a rescue therapy. They discuss how milrinone may influence both systemic and cerebral hemodynamics, as well as the role of CT perfusion imaging in evaluating cerebral blood flow and perfusion heterogeneity.

They also review findings from the retrospective study, including milrinone's association with increased cardiac index but not a consistent increase in cerebral blood flow. Among patients who did not develop delayed cerebral ischemia, cerebral perfusion became more spatially homogeneous as the milrinone dose increased. Dr. Robba explains why the distribution of cerebral blood flow may be more informative than its average value, the potential of perfusion heterogeneity as a marker of treatment response and why larger prospective studies are needed before these findings can inform changes in clinical practice.

The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

In this episode of the NCS Podcast Currents series, host Lauren Koffman, DO, MS, speaks with Gisele Sampaio Silva about the Currents article, "Breaking Barriers: How Brazil's RESILIENT Trials Redefined Stroke Research in Latin America."

Sampaio Silva discusses how the RESILIENT trial demonstrated that mechanical thrombectomy can be delivered safely and effectively within Brazil's public health system. She explains why researchers needed to evaluate the treatment in a middle-income country with significant regional differences in hospital resources, prehospital transportation, imaging access and stroke care infrastructure.

The conversation also explores the partnerships and advocacy required to conduct the multicenter trial, including support from Brazil's Ministry of Health, international researchers and industry collaborators. Silva reflects on how the trial helped pave the way for the approval of mechanical thrombectomy within Brazil's public health system, the persistent gaps in access across the country and the importance of expanding international research partnerships to improve stroke care in resource-limited settings.

To read the full article, visit NCS Currents.

The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

In this episode of the NCS Podcast Currents series, host Lauren Koffman, DO, MS, speaks with Shraddha Mainali, Sahar Zafar and Brooke Murtaugh about their Currents article, "Neurocritical Care Disorders of Consciousness: Do We Have the Education We Need to Provide Care?"

The guests discuss the clinical spectrum of disorders of consciousness and the importance of accurately assessing patients using standardized bedside examinations, neuroimaging and other multimodal tools. They also examine the role of neuroprognostication in guiding conversations with families and ensuring that patients are given appropriate opportunities for recovery.

The conversation explores findings from a pilot survey on educational needs related to disorders of consciousness. The panel discusses barriers to care and education, including limited access to centralized resources, time constraints and knowledge gaps in assessment, diagnosis, prognosis and treatment. They also highlight the Curing Coma® Campaign's efforts to expand access to evidence-based education through webinars, online resources, World Coma Day and interdisciplinary global collaboration.

To read the full article, visit NCS Currents.

The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.