Thevathasan, Tharusan

Abstract Psychological distress, moral injury, and burnout are prevalent among intensive care unit (ICU) professionals, impacting individual well-being, team dynamics, and patient safety. Structured peer support programmes, delivered by trained colleagues rather than mental health professionals, could be implemented as low-threshold, scalable interventions to promote psychological safety and resilience. This review outlines five foundational pillars for implementing peer support in the ICU, including formal programme design, training, inclusivity, confidentiality, and continuous evaluation. It also addresses practical strategies to overcome cultural and institutional barriers, such as stigma, time constraints, and hierarchical norms. Drawing on current evidence and recent unpublished survey data from North American critical care cardiologists, the article provides a practical framework for integrating peer support into ICU culture. Peer support represents a complementary approach to formal mental health services and offers tangible benefits for clinician well-being, retention, and quality of care.

Abstract Aims The Society for Cardiovascular Angiography and Interventions (SCAI) Classification provides risk stratification of patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS). This sub-study of the ECLS-SHOCK trial investigates the prognostic impact of SCAI stages in AMI-CS and the influence of SCAI stages on the effect of extracorporeal life support (ECLS) therapy in AMI-CS patients. Methods Patients with AMI-CS enrolled in the multicentre, randomized ECLS-SHOCK trial were included. The outcomes, treatment effect and safety of ECLS were stratified according to SCAI stage at admission using a post-hoc classification. Results From a total of 417 patients enrolled in the ECLS-SHOCK trial between June 2019 and November 2022, 51.6% (n = 215), 13.4% (n = 56) and 35.0% (n = 146) presented in SCAI Stages C, D and E, respectively. SCAI stages were associated with the risk of 30 day all-cause mortality (C vs. D vs. E: 32.6% vs. 67.9% vs. 64.4%, P < 0.001), with rates of renal replacement therapy at 30 days (C vs. D vs. E: 7.0% vs. 19.6% vs. 13.7%, P = 0.03) and with poor neurological outcomes (C vs. D vs. E: 17.2% vs. 44.4% vs. 36.5%, P < 0.001). No interaction was observed between SCAI stage and the treatment effect of ELCS on 30 day all-cause mortality (ELCS vs. control SCAI C: 32.7% vs. 32.4%; SCAI D: 68.4% vs. 66.7%; SCAI E: 59.7% vs. 68.4%, P for interaction = 0.65). Conclusions In AMI-CS patients included in the ECLS-SHOCK trial, SCAI stages at admission were predictive for mortality and for the incidence of safety events. The efficacy of ECLS treatment was not affected by SCAI stage.

Introduction: Studying the clinical nature of myocarditis on a broad scale across age and sex groups is required to investigate risk factors and patterns of disease. This study aimed to examine patient- and hospital-centered characteristics of patients being hospitalized for myocarditis. Hypothesis: Sex differences in myocarditis prevalence are dependent on age. Methods and Results: We included all patients being hospitalized in three tertiary care centers between 1999 and 2021 with a diagnosis of acute or chronic myocarditis. We utilized Chi-square, T-test, Fisher exact or Wilcoxon-Mann-Whitney U tests. 7,031 patients with acute or chronic myocarditis were included in total. 231 (3.3%) were of pre-pubescent age (<13 years if male, <11 years if female), 410 (5.8%) were adolescent patients (<18 years), 2,089 (29.7%) young adults (18-35 years), 2,535 (36.1%) middle-aged adults (35-54 years) and 1,766 (25.1%) patients were over 54 years (post-menopausal age). The diagnosis of myocarditis was confirmed by endomyocardial biopsy in 1,337 patients (19%), while it was based on clinical parameters and/or magnetic resonance imaging in the remaining patients. Adolescent patients had the highest levels of procalcitonin (6.98 ±44.6 μg/l), troponin T (450 ±1,550 ng/l) and creatine kinase (360 ±677U/l), while pre-pubescent patients had the highest levels of anti-streptolysin antibody (320 ±470 kU/l) and NT-proBNP (14,000 ±20,800ng/l) compared to all other age groups. Left-ventricular ejection fraction decreased over age groups from 60 ±4% in adolescent patients to 44.0 ±16% in senior patients. The strongest sex difference in myocarditis frequency was observed in young (608 female vs. 1,481 male; P<0.001) and middle-aged adults (1,025 female vs. 1,510 male; P<0.001) (see Figure 1). Conclusion: Strong sex differences in myocarditis prevalence were particularly observed in young and middle-aged patients. Sex hormones may determine the risk of developing myocarditis.