Toronto General Hospital | Critical Care Medicine

Key Contacts

Dr Ghislaine Douflé
MD
Dr Laura Dragoi
MD

TGH Specific

These resources are specific to clinical situations you may encounter in the TGH ICU. They are intended for ICU fellows or residents with substantial previous ICU exposure. For residents new to the ICU, we recommend focusing your learning on the concepts presented on the General ICU page.

At TGH, we care for a large number of critically ill patients on ECMO as well as post-lung or -liver transplant. We also frequently see patients with pulmonary hypertension and manage patients following pulmonary thromboendarterectomy.

ECMO 101

With the biggest extracorporeal life-support (ECLS) program in Canada, you will manage many patients on ECMO during your time in the TGH ICU. We care for venovenous (VV) and venoarterial (VA) ECMO patients. The approach to their care is very multidisciplinary with the involvement of thoracic surgeons, cardiologists specializing in advanced heart failure, perfusionists, and respiratory therapists.

The resources below will provide you with a basic overview of ECMO as well as troubleshooting principles that may be useful on call. For residents, it is helpful to have a basic understanding of the ECMO circuit but you will not be expected to manage patients on ECMO without direct supervision from the ICU fellows and attendings.

ECMO 101: Another excellent free resource that covers the basics of ECMO.
icuECMO: Excellent quick reference
ICU OnePagers on ECMO Fundamentals and ECMO troubleshooting
Videos and resources made by the TGH perfusionists for managing ECMO
Spotlight on ECMO – Fundamental Concepts in Extracorporeal Life Support: Excellent series taught by Dr. Eddy Fan and other ECMO experts. Requires a free login to access but this is highly recommended for fellows starting a rotation at TGH. Though the videos have expired, you can still access the slides and other resources.
It’s also important to know when ECMO is unlikely to help, which is outlined nicely in this paper, Ten situations in which ECMO is unlikely to be successful.

Useful Papers:

Lung Transplant

TGH hosts one of the largest lung transplant programs in the world. You will see a large number of lung transplant recipients in your time at TGH, and it is useful to become acquainted with some basics around the management of this patient population before you start your rotation. Here we have gathered a few useful resources to help you start your reading.

Here you can find an excellent article by transplant surgeons at TGH detailing how lung transplant surgery is performed.
There is also this excellent U of T lung transplant manual that is worth reviewing.
If managing patients post-lung transplant, please be aware of this TGH standardized post-lung transplant management protocol.
Finally, here is a useful powerpoint named "Postoperative management of lung transplant recipients in the ICU" from the TGH lung transplant program about considerations for immediate post-operative management of lung transplant recipients in the ICU.
This is a great article from Anesthesia in 2021 on the Postoperative Management of Lung Transplant Recipients in the Intensive Care Unit

Liver Transplant

Useful articles on liver transplantation can be found below:

Pulmonary Thromboendarterectomy

TGH is a centre with expertise in managing patients with pulmonary hypertension and pulmonary thromboembolic disease. Patients who undergo pulmonary endarterectomies are routinely admitted to the TGH ICU for post-operative management.

This slideshow provides a nice summary of pulmonary embolic disease.
This is an excellent presentation by one of the practitioners on the team on the management of patients with chronic pulmonary hypertension due to thromboembolic disease.
Finally, here is a nice review article from 2011 by our very own Dr. John Granton on pulmonary hypertension in the ICU.