Want to know more about PRECARE and physiology-guided advanced life support? Dr Natalie Kruit and Dr Samuel Bulford have created a series of podcasts dedicated to this advancing and fascinating area of medicine, in which they chat with world-leading experts about current and emerging resuscitation research, the physiology of the arrested patient and the approach of different pre-hospital systems around the world in the management of the out of hospital cardiac arrest patient – and much more.

Listen to all episodes now on spotify and apple podcasts – links below!

Spotify: https://open.spotify.com/show/2cUYDuCcaOVwdZglCZnuFV?si=4ce42b6615654684

Apple podcasts: https://podcasts.apple.com/us/podcast/greater-sydney-area-hems/id602038154

PRECARE in Sydney – what is it, why is it important, and how do we do it

Join Sam, Nat and Alex to discuss the early stages of the PRECARE pre-hospital ECMO trial in Sydney. Nat and Alex share their experiences in the creation and go-live of the trial, how to integrate into existing team workflows, as well as the challenges and successes encountered to date.

Listen now on apple podcasts: https://podcasts.apple.com/us/podcast/hems-debrief-repost-an-introduction-to-precare/id602038154?i=1000734737034

Listen now on spotify: https://open.spotify.com/episode/5klJLIQtvfcGxJPhXlRgeh?si=f0b3385db3cc43da

Episode 1 – Dr Paul Rees

We have the privilege of talking with Dr Paul Rees.

Who better to talk all things myocardial perfusion and it’s optimisation during cardiac arrest than an interventional cardiologist and pre-hospital physician. Paul explains the physiology of cardiac arrest from an interventional cardiologist perspective as we ask him the hard questions on:

• Optimal diastolic blood pressure thresholds to improve ROSC
• The role of adrenaline in improving coronary artery perfusion, the downside to it’s administration and the potential alternatives 
• The role of selective aortic aortic arch perfusion (SAAP), the current ERICA study and the potential for this procedure to improve cardiac arrest survival 
• The key elements in building a successful endovascular resuscitation program for those services wishing to embark on ECPR and/or REBOA

Listen now on spotify: https://open.spotify.com/episode/49POyUELcfbgYZTzdXLwH5?si=2e58eeac3d4d430f

Listen now on apple podcasts: https://podcasts.apple.com/us/podcast/hems-debrief-cardiac-arrest-focus-1-dr-paul-rees/id602038154?i=1000732785949

Episode 2 – Dr Tommaso Scquizzato

In the second episode of this series, we talk to Dr Tommaso Scquizatto from Milan, Italy.

Tommaso is a Doctor, researcher and innovator in cardiac arrest, resuscitation, and emergency critical care medicine. He works in the Department of Anaesthesia and Intensive Care at IRCCS Ospedale San Raffaele in Milan, Italy, where he leads cardiac arrest research and innovation.

His clinical and research efforts focus on improving the entire chain of survival for out-of-hospital cardiac arrest, from prevention to advanced resuscitation, including the use of extracorporeal life support and novel technologies. He serves on the Advanced Life Support (ALS) Task Force of the International Liaison Committee on Resuscitation (ILCOR) and the 2025 Guidelines Working Groups for BLS, ALS, and extracorporeal CPR of the European Resuscitation Council (ERC). He is also an editorial board member and social media editor for Resuscitation and Resuscitation Plus.

With Tommaso in this episode, we talk about targeted physiology in cardiac arrest included targeted diastolic blood pressure, Tommaso’s research, and how systems and workflows may adapt to incorporate new intra-ACLS interventions such as transoesophageal ECHO.

Listen now on spotify: https://open.spotify.com/episode/6zqTEHf4maaBwhPgmQ2iom?si=808c3f147c984a8b

Listen now on apple podcasts: https://podcasts.apple.com/us/podcast/hems-debrief-cardiac-arrest-focus-2-dr-tommaso-scquizzato/id602038154?i=1000713002633

Episode 3 – Dr Hans van Schuppen – part 1

It is time to put the P back into CPR. Ventilation has been neglected in cardiac arrest management, and this two part episode focuses on how ventilation can not only help achieve a ROSC but the importance of ventilation too in achieving neurologically intact survival

• We debate 30:2 or continuous ventilation and the merits of LMA vs intubation vs BVM
• We talk about the complexities of heart lung interactions
• Where the research is heading in understanding how best to ventilate these patients

We are delighted to be joined by an absolute expert in this area, Dr Hans van Schuppen from Holland.

Hans is an anesthesiologist and HEMS physician at the Amsterdam University Medical Centre. Hans is a combined researcher, clinician and leader. He is an ERC Advanced Life Support Course Director, co-founder of the ResusNL conference, member of the expert group on national ambulance guidelines on resuscitation and is a member of the jury of the Dutch National Resuscitation Competition. As a member of the Dutch Resuscitation Council, he co-authored the national resuscitation guidelines, and helped to develop and implement a nationwide standard operating procedure for the handover of out-of-hospital cardiac arrest patients.

Currently, Hans is the chair of the Medical Committee and board member of the Dutch Resuscitation Council. His research evolved into a formal PhD with the ARREST (AmsteRdam REsuscitation STudies) group and the department of Anesthesiology, resulting in his thesis “Prehospital Advanced Life Support”. He now serves as director of resuscitation science of ARREST and works towards close collaboration between clinical care, education, research and innovation in resuscitation.

We could not stop talking to Hans, so be sure to listen to part 2 below!

Listen now on spotify: https://open.spotify.com/episode/2ROYtk65uhtwNpyaYieFU0?si=4c77e19345b94b63

Listen now on apple podcasts: https://podcasts.apple.com/us/podcast/hems-debrief-cardiac-arrest-focus-3-dr-hans-van-schuppen/id602038154?i=1000714429687

Episode 3 – Dr Hans van Schuppen – part 2

This is the second half of our chat with Dr Hans van Schuppen from Amsterdam as we put the P back into CPR.

In today’s episode, we discuss amongst other things:

• Lung recruitment intra-arrest
• The impact of tidal volumes during arrest
• To PEEP or not to PEEP during arrest
• How to use ventilation to prevent acidosis during arrest

Join now as we continue to pick Hans’ brain, and as ever we hope you enjoy this and subsequent episodes.

Listen now on spotify: https://open.spotify.com/episode/1DE5MafjXTi6cORC4aLUvO?si=46465c6a615e4519

Listen now on apple podcasts: https://podcasts.apple.com/us/podcast/hems-debrief-cardiac-arrest-focus-4-dr-hans-van-schuppen/id602038154?i=1000715045828

Episode 5 – Prof Laurie Morrison

As we continue to discuss cardiac arrest, this week we talk with Prof Laurie Morrison from Toronto about:

• How to integrate cardiac arrest research into an existing systems
• How to gather and interpret physiologic data during arrest – particularly ventilation data – and what to do with this data to optimise arrest care
• How to be a leader in this research field

Prof Morrison is an academic and Clinical Scientist in the Division of Emergency Medicine, Department of Medicine at the University of Toronto and Sunnybrook Health Sciences Centre. Her program of research focuses on the evaluation and implementation of time sensitive interventions in acute emergencies, including cardiac arrest.

Laurie is a member of ILCOR, where she has been named a ‘Giant in Resuscitation’. Outside of ILCOR, Laurie has led the way establishing ‘Rescu’ – a collaborative prehospital research network wherein investigators conduct randomised controlled trials and outcome validation studies in resuscitation research. Laurie continues to provide leadership to several committees including the network of Canadian Emergency Medicine Researchers, and she has has received honorary membership to the European Resuscitation Council for life time achievement in resuscitation science.

Listen now on spotify: https://open.spotify.com/episode/3PU27bXGPdVjTYvisnqkxG?si=a851876211064a3f

Listen now on apple podcasts: https://podcasts.apple.com/us/podcast/hems-debrief-cardiac-arrest-focus-5-prof-laurie-morrison/id602038154?i=1000716012134

Episode 6 – Dr Felipe Teran

We are joined by Dr Felipe Teran from New York, discussing trans-oesophageal ECHO (TOE) in arrest.

Felipe is an Associate Professor of Emergency Medicine at Weill Cornell Medical College, New York. Additionally, Felipe is a clinical scientist and educational leader specifically focused on the utility and application of TOE during cardiac arrest. Indeed, Felipe is leading the way integrating this intervention into ACLS efforts.

In this episode, Sam, Nat and CCP Jackie chat with Felipe about the literature to date demonstrating the application of TOE in arrest to best optimise chest compression position to promote forward flow. In so doing, resuscitation providers can attempt to avoid a left ventricular outflow tract obstruction, and are better able to continually assess the effectiveness of ACLS – noting that the heart can change position throughout arrest.

Additionally, Nat talks about her and the team’s experience of pre-hospital TOE within the New South Wales Ambulance system, in particular how TOE can be utilised as part of a toolkit of assessment during arrest to assess the effectiveness of a resuscitation – even in the absence of placing a patient onto ECMO. Linked to this, Jackie describes the effect of live physiologic guidance and feedback to the paramedic workforce in New South Wales.

Listen now on spotify: https://open.spotify.com/episode/4FnBKq8FWwr3I33ySdGLri?si=6f49a15a26a74ce4

Listen now on apple podcasts: https://podcasts.apple.com/us/podcast/hems-debrief-cardiac-arrest-focus-6-dr-felipe-teran/id602038154?i=1000717086866

Episode 7 – Prof Jimmy Chien

We are joined by a Sydney local – Prof Jimmy Chien, as we talk about PE in cardiac arrest.

Jimmy is a Senior Staff Specialist (Senior Consultant) in Respiratory Medicine, with a sub-speciality focus on pulmonary embolism. Jimmy has been fundamental in the creation of the PE emergency response team at his tertiary facility in Sydney, as well as in the roll-out of similar multi-disciplinary teams across Australia. On a daily basis, Jimmy and his team encounter the most challenging PE patients – those with intermediate or high risk PE, as well as those in arrest.

In this episode, Nat, Jimmy and Sam unpack how a PE causes an arrest, how to ascertain if a patient has arrested secondary to a massive PE, the therapies available to those patients who have arrested due to a known or suspected PE, and the role of mechanical support including ECMO. Too, Jimmy is quizzed on where the literature is taking us to help manage this cohort of patients, as well as some of the emerging post-therapy care plans.

Listen now on spotify: https://open.spotify.com/episode/0RR1xtQepTAfmGRNZWfq6I?si=1f0121b61854496b

Listen now on apple podcasts: https://podcasts.apple.com/us/podcast/hems-debrief-cardiac-arrest-focus-7-professor-jimmy-chien/id602038154?i=1000718188494

Episode 8 – Michael Heller

Join us as we talk through the physics of defibrillation, what is needed to get defibrillation as good as it can be, and what to do when defibrillation is simply not working.

We are delighted to be joined by Michael Heller. Michael is a paramedic by background, who now works as a medical engineer focused on defibrillation. Michael studied Rescue Engineering in Germany, and combining his clinical background is now a defining expert voice on defibrillation, and an excellent educator.

Too, we are delighted to be joined again by CCP Jackie, the educator for the Sydney pre-hospital ECMO/cardiac arrest car. In this episode, Jackie reflects on her experience backing up crews attending cardiac arrests, and how this experience has shaped her appreciation of the importance of good and judicious defibrillation, the barriers to making this happen, and how we as providers can all improve our defibrillation practice.

Listen now on spotify: https://open.spotify.com/episode/1QezYuTBHXRwU5yr5Naq8N?si=6135c007847046e5

Listen now on apple podcasts: https://podcasts.apple.com/us/podcast/hems-debrief-cardiac-arrest-focus-8-michael-heller/id602038154?i=1000719414161

Episode 9 – Dr Mike Lauria – part 1

In this part one of two episodes, we are pivoting away from the technical towards human factors and team performance. In doing this, we are thrilled to be joined by Dr Mike Lauria.

Mike is a human factors legend. Prior to becoming a Doctor, Mike served as an elite Pararescueman in the 321st Special Tactics Squadron during which time he won numerous service awards. Then, Mike became the lead instructor of a tactical training group before moving back to New Hampshire to work as a Critical Care and Flight paramedic. If that wasn’t enough, Mike then went to and graduated from Medical School before completing his residency in Emergency Medicine, as well as fellowships in EMS and Critical Care, at the University of New Mexico Health Science Center.

Currently, Mike works as an attending critical care and EMS physician at the University of Washington, and is the Associate Medical Director at Airlift Northwest.

Suffice to say, Mike brings an exceptional wealth of experience and perspective on what constitutes a high performing team and a high performing individual, and the factors required to maintain operational momentum even during unfavourable circumstances. Nat and Mike discuss this and much more in what are two episodes full of absolute gold.

Listen now on spotify: https://open.spotify.com/episode/1msFNYMrB864Y1FYl01AaJ?si=ae25c1a22c4a4ebe

Listen now on apple podcasts: https://podcasts.apple.com/us/podcast/hems-debrief-cardiac-arrest-focus-9-dr-mike-lauria-part-1/id602038154?i=1000722361645

Episode 10 – Dr Mike Lauria – part 2

In this episode, Nat and Mike discuss more human factors gold including but not limited to how to accept imperfection and continue to deliver optimal team performance when things are going south, how to instil calm in a team whilst maintaining the momentum of care, and how to adapt and pivot whilst maintaining optimal process.

Listen now on spotify: https://open.spotify.com/episode/0LKJ35kkhpc82wRS9vHHQ5?si=c5b536fb65ca4bab

Listen now on apple podcasts: https://podcasts.apple.com/us/podcast/hems-debrief-cardiac-arrest-focus-10-dr-mike-lauria-part-2/id602038154?i=1000723358498

Episode 11 – Dr Úna Nic Ionmhain

Today, we are pivoting towards toxicology. Specifically, we discuss some of the more common toxidromes encountered pre-hospitally, how they cause cardiac arrest, and what providers – in particular pre-hospital providers – may do in order to best resuscitate these patients.

In addition to some broader and very applicable learning themes pertinent to any toxidrome, we discuss

• Beta-blockers
• Calcium channel blockers
• Amitriptyline
• Quetiapine
• …and more

Of course we are not doing discussing this alone. We are so luck to be joined today by a clinical toxicologist, Dr Úna.

Dr Úna Nic Ionmhain graduated from Trinity College Dublin, and subsequently trained in Emergency Medicine in Perth. She completed a Pre Hospital and Retrieval Medicine year with CareFlight NSW as well as a poisons fellowship. She is now a staff specialist FACEM at Liverpool Hospital NSW, and a clinical toxicologist with the NSW Poisons Information Centre. She has an academic interest in HIET in toxicology for cardiogenic shock, which was the focus of her masters thesis, and is a passionate educator with a particular interest in cardiotoxicity.

Listen now on spotify: https://open.spotify.com/episode/6ENBPb4hpbtFeONNTkWlX3?si=f0da88549a1c4591

Listen now on apple podcasts: https://podcasts.apple.com/us/podcast/hems-debrief-cardiac-arrest-focus-11-dr-%C3%BAna-nic-ionmhain/id602038154?i=1000726809834

Episode 12 – Dr Per Olave (PO) Berve -part 1

Today we have part one of two in conversation with Dr PO Berve from Norway. PO is an Anaesthetist and Pre-Hospital physician from Oslo where he works on the physician response car of the region. PO’s research has been absolutely fundamental to the modern understanding of CPR physiology and the haemodynamics of the arrested patient, and his work is rightly lauded as critical in the practice of physiology-guided resuscitation. 

Have you ever wondered what happens during one chest compression? In this episode, Nat deep-dives with PO into the physiology of the arrested patient – specifically what happens, or what should happen, during one perfect chest compression. It’s a fascinating conversation not to be missed by anyone with an interest in performing high quality resuscitation tailored to a specific patient. 

Listen now on spotify: https://open.spotify.com/episode/3Z0YWTSG5TngKDN1rhEaXo?si=99748a6e62f94bb5

Listen now on apple podcasts: https://podcasts.apple.com/us/podcast/hems-debrief-cardiac-arrest-focus-12-dr-per-olave-po-berve/id602038154?i=1000733226017

Episode 13 – Dr Per Olave (PO) Berve – part 2

Welcome back, this is part two of Nat’s chat with Dr PO Berve from Norway. 

Continuing the conversation, Nat and PO discuss physiological markers of ALS effectiveness as well as broach how to most judiciously use adrenaline during cardiac arrest. Too, PO dives into how to use the end tidal capnogram as a marker of CPR effectiveness – and it is not how you may think!

Of course, this would not be a Sydney HEMS debrief episode without talking about eCPR and ventilation during CPR – the later being a favourite topic of Nat’s for sure.

As ever, thanks for listening and chat again soon.

Listen now on spotify: https://open.spotify.com/episode/2U5b3n0YjRgrYEz3lOq4j6?si=v03Y6eiiRGCSXgfk_rEx1A

Listen now on apple podcasts: https://podcasts.apple.com/us/podcast/hems-debrief-cardiac-arrest-focus-13-dr-per-olave-po/id602038154?i=1000736074009

Episode 14 – Dr Caroline Leech

G’day and welcome back to the Sydney HEMS debrief, with our focus still firmly on cardiac arrest. 

In this episode 14, Nat is joined by Dr Helen Oliver in conversation with Dr Caroline Leech from the UK. Caroline is an emergency and pre-hospital physician who’s academic interest focuses on maternal cardiac arrest. Specifically, Caroline’s work concerns resuscitative hysterotomy; the when, the how, and the what to do after performing this HALO procedure. 

Additionally, Nat, Helen and Caroline discuss the physiology of maternal cardiac arrest and how we can best optimise our holistic resuscitation care as well as some of the ethical considerations surrounding this very challenging and confronting circumstance. 

We hope you enjoy this challenging episode, and of course share widely with your network. 

Chat soon.

Listen now on spotify: https://open.spotify.com/episode/1QDEKrX0ZyGwe8lVH5wPx4?si=37ZjTtYOR7SMW_E0QLK5GA

 Listen now on apple podcasts: https://podcasts.apple.com/us/podcast/hems-debrief-cardiac-arrest-focus-14-dr-caroline-leech/id602038154?i=1000738088756

Episode 15 – The Paris Perspective

G’day and welcome back to the Sydney HEMS Debrief podcast – this is our focused mini-series on Cardiac Arrest. 

Today’s episode is a big one. We have the absolute privilege of speaking to the Dr Alice Hutin and Prof Lionel Lamhaut from the pre-hospital ECMO team in Paris, France. 

The team, part of the Service d’Aide Medical d’Urgence (aka SAMU) in Paris, have been performing pre-hospital ECMO for OOHCA since 2011. For the past 10 years, the team have been available 24/7, working in concert with the pre-hospital ICU team dispatched to cardiac arrests in the greater Paris region. 

Truly ground-breaking, Alice and Lionel join us to reflect on over a decade of pre-hospital ECPR care, system implementation and challenges. Too, and perhaps most significantly, Alice and Lionel reflect on the extent to which the pre-hospital ECPR service has influenced every step of the chain of survival in the Paris system – promoting high quality basic and advanced life support at multiple levels within the pre-hospital response. 

Too, Sam does not shy away from asking some tough questions around just who should be performing ECPR – high specialised, limited access services or should this therapy be adopted and delivered more widely. 

This is part one of a two part episode, and is an absolute cracker. 

Be sure to tune in to part two very soon!

Listen now on spotify: https://open.spotify.com/episode/5sFi61EQ4BD5spQqpSjLab?si=8a39a9c087c74f36

 Listen now on apple podcasts: https://podcasts.apple.com/us/podcast/hems-debrief-cardiac-arrest-focus-15-the-perspective/id602038154?i=1000740142635

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