Daniel Aaron Gerber, MD

All Publications

• Characteristics, Therapies, and Outcomes of In-Hospital vs Out-of-Hospital Cardiac Arrest in Patients Presenting to Cardiac Intensive Care Units: From the Critical Care Cardiology Trials Network (CCCTN). Resuscitation Carnicelli, A. P., Keane, R., Brown, K. M., Loriaux, D. B., Kendsersky, P., Alviar, C. L., Arps, K., Berg, D. D., Bohula, E. A., Burke, J. A., Dixson, J. A., Gerber, D. A., Goldfarb, M., Granger, C. B., Guo, J., Harrison, R. W., Kontos, M., Lawler, P. R., Elliott Miller, P., Nativi-Nicolau, J., Kristin Newby, L., Racharla, L., Roswell, R. O., Shah, K. S., Sinha, S. S., Solomon, M. A., Teuteberg, J., Wong, G., van Diepen, S., Katz, J. N., Morrow, D. A. 2022

  Abstract

  BACKGROUND: Cardiac arrest (CA) is a common reason for admission to the cardiac intensive care unit (CICU), though the relative burden of morbidity, mortality, and resource use between admissions with in-hospital (IH) and out-of-hospital (OH) CA is unknown. We compared characteristics, care patterns, and outcomes of admissions to contemporary CICUs after IHCA or OHCA.METHODS: The Critical Care Cardiology Trials Network is a multicenter network of tertiary CICUs in the US and Canada. Participating centers contributed data from consecutive admissions during 2-month annual snapshots from 2017 to 2021. We analyzed characteristics and outcomes of admissions by IHCA vs OHCA.RESULTS: We analyzed 2,075 admissions across 29 centers (50.3% IHCA, 49.7% OHCA). Admissions with IHCA were older (median 66 vs 62 years), more commonly had coronary disease (38.3% vs 29.7%), atrial fibrillation (26.7% vs 15.6%), and heart failure (36.3% vs 22.1%), and were less commonly comatose on CICU arrival (34.2% vs 71.7%), p<0.001 for all. IHCA admissions had lower lactate (median 4.3 vs 5.9) but greater utilization of invasive hemodynamics (34.3% vs 23.6%), mechanical circulatory support (28.4% vs 16.8%), and renal replacement therapy (15.5% vs 9.4%); p<0.001 for all. Comatose IHCA patients underwent targeted temperature management less frequently than OHCA patients (63.3% vs 84.9%, p<0.001). IHCA admissions had lower unadjusted CICU (30.8% vs 39.0%, p<0.001) and in-hospital mortality (36.1% vs 44.1%, p<0.001).CONCLUSION: Despite a greater burden of comorbidities, CICU admissions after IHCA have lower lactate, greater invasive therapy utilization, and lower crude mortality than admissions after OHCA.

  View details for DOI 10.1016/j.resuscitation.2022.12.002

  View details for PubMedID 36521683

• De Novo vs Acute-on-Chronic Presentations of Heart Failure-Related Cardiogenic Shock: Insights from the Critical Care Cardiology Trials Network Registry. Journal of cardiac failure Bhatt, A. S., Berg, D. D., Bohula, E. A., Alviar, C. L., Baird-Zars, V. M., Barnett, C. F., Burke, J. A., Carnicelli, A. P., Chaudhry, S., Daniels, L. B., Fang, J. C., Fordyce, C. B., Gerber, D. A., Guo, J., Jentzer, J. C., Katz, J. N., Keller, N., Kontos, M. C., Lawler, P. R., Menon, V., Metkus, T. S., Nativi-Nicolau, J., Phreaner, N., Roswell, R. O., Sinha, S. S., Jeffrey Snell, R., Solomon, M. A., Van Diepen, S., Morrow, D. A. 2021; 27 (10): 1073-1081

  Abstract

  BACKGROUND: Heart failure-related cardiogenic shock (HF-CS) accounts for an increasing proportion of cases of CS in contemporary cardiac intensive care units. Whether the chronicity of HF identifies distinct clinical profiles of HF-CS is unknown.METHODS AND RESULTS: We evaluated admissions to cardiac intensive care units for HF-CS in 28 centers using data from the Critical Care Cardiology Trials Network registry (2017-2020). HF-CS was defined as CS due to ventricular failure in the absence of acute myocardial infarction and was classified as de novo vs acute-on-chronic based on the absence or presence of a prior diagnosis of HF, respectively. Clinical features, resource use, and outcomes were compared among groups. Of 1405 admissions with HF-CS, 370 had de novo HF-CS (26.3%), and 1035 had acute-on-chronic HF-CS (73.7%). Patients with de novo HF-CS had a lower prevalence of hypertension, diabetes, coronary artery disease, atrial fibrillation, and chronic kidney disease (all P < 0.01). Median Sequential Organ Failure Assessment (SOFA) scores were higher in those with de novo HF-CS (8; 25th-75th: 5-11) vs acute-on-chronic HF-CS (6; 25th-75th: 4-9, P < 0.01), as was the proportion of Society of Cardiovascular Angiography and Intervention (SCAI) shock stage E (46.1% vs 26.1%, P < 0.01). After adjustment for clinical covariates and preceding cardiac arrest, the risk of in-hospital mortality was higher in patients with de novo HF-CS than in those with acute-on-chronic HF-CS (adjusted hazard ratio 1.36, 95% confidence interval 1.05-1.75, P = 0.02).CONCLUSIONS: Despite having fewer comorbidities, patients with de novo HF-CS had more severe shock presentations and worse in-hospital outcomes. Whether HF disease chronicity is associated with time-dependent compensatory adaptations, unique pathobiological features and responses to treatment in patients presenting with HF-CS warrants further investigation.

  View details for DOI 10.1016/j.cardfail.2021.08.014

  View details for PubMedID 34625127

• Management and Outcomes of Cardiogenic Shock in Cardiac ICUs With Versus Without Shock Teams. Journal of the American College of Cardiology Papolos, A. I., Kenigsberg, B. B., Berg, D. D., Alviar, C. L., Bohula, E., Burke, J. A., Carnicelli, A. P., Chaudhry, S. P., Drakos, S., Gerber, D. A., Guo, J., Horowitz, J. M., Katz, J. N., Keeley, E. C., Metkus, T. S., Nativi-Nicolau, J., Snell, J. R., Sinha, S. S., Tymchak, W. J., Van Diepen, S., Morrow, D. A., Barnett, C. F. 2021; 78 (13): 1309-1317

  Abstract

  Single-center studies suggest that implementation of multidisciplinary cardiogenic shock (CS) teams is associated with improved CS survival.The aim was to characterize practice patterns and outcomes in the management of CS across multiple centers with versus without shock teams.The Critical Care Cardiology Trials Network is a multicenter network of cardiac intensive care units (CICUs) in North America. All consecutive medical admissions to each CICU (n = 24) were captured during annual 2-month collection periods (2017-2019; n = 6,872). Shock management and CICU mortality among centers with versus without shock teams were compared using inverse probability weighting.Ten of the 24 centers had shock teams. Among 1,242 CS admissions, 44% were at shock team centers. The groups were well-balanced with respect to demographics, shock etiology, Sequential Organ Failure Assessment score, biochemical markers of end organ dysfunction, and invasive hemodynamics. Centers with shock teams used more pulmonary artery catheters (60% vs 49%; adjusted odds ratio [OR]: 1.86; 95% CI: 1.47-2.35; P < 0.001), less overall mechanical circulatory support (MCS) (35% vs 43%; adjusted OR: 0.74; 95% CI: 0.59-0.95; P = 0.016), and more advanced types of MCS (53% vs 43% of all MCS; adjusted OR: 1.73; 95% CI: 1.19-2.51; P = 0.005) rather than intra-aortic balloon pumps. The presence of a shock team was independently associated with lower CICU mortality (23% vs 29%; adjusted OR: 0.72; 95% CI: 0.55-0.94; P = 0.016).In this multicenter observational study, centers with shock teams were more likely to obtain invasive hemodynamics, use advanced types of MCS, and have lower risk-adjusted mortality. A standardized multidisciplinary shock team approach may improve outcomes in CS.

  View details for DOI 10.1016/j.jacc.2021.07.044

  View details for PubMedID 34556316

• Advanced Respiratory Support in the Contemporary Cardiac ICU. Critical care explorations Metkus, T. S., Miller, P. E., Alviar, C. L., Baird-Zars, V. M., Bohula, E. A., Cremer, P. C., Gerber, D. A., Jentzer, J. C., Keeley, E. C., Kontos, M. C., Menon, V., Park, J., Roswell, R. O., Schulman, S. P., Solomon, M. A., van Diepen, S., Katz, J. N., Morrow, D. A. 2020; 2 (9): e0182

  Abstract

  The medical complexity and critical care needs of patients admitted to cardiac ICUs are increasing, and prospective studies examining the underlying cardiac and noncardiac diagnoses, the management strategies, and the prognosis of cardiac ICU patients with respiratory failure are needed.Design: Prospective cohort study.Setting: The Critical Care Cardiology Trials Network is a research collaborative of cardiac ICUs across the United States and Canada.Patients: We included all medical cardiac ICU admissions at 25 cardiac ICUs during two consecutive months annually at each center from 2017 to 2019.Measurements: We evaluated the use of advanced respiratory therapies including invasive mechanical ventilation, noninvasive ventilation, and high-flow nasal cannula versus no advanced respiratory support across admission diagnoses and the association with in-hospital mortality.Main Results: Of 8,240 cardiac ICU admissions, 1,935 (23.5%) were treated with invasive mechanical ventilation, 573 (7.0%) with noninvasive ventilation, and 281 (3.4%) with high-flow nasal cannula. Admitting diagnoses among those with advanced respiratory support were diverse including general medical problems in patients with heart disease as well as primary cardiac problems. In-hospital mortality was higher in patients who received invasive mechanical ventilation (38.1%; adjusted odds ratio, 2.53; 2.02-3.16) and noninvasive ventilation or high-flow nasal cannula (8.8%; adjusted odds ratio, 2.25; 1.73-2.93) compared with patients without advanced respiratory support (4.6%). Reintubation rate was 7.6%. The most common variables associated with respiratory insufficiency included heart failure, infection, chronic obstructive pulmonary disease, and pulmonary vascular disease.Conclusions: One-third of cardiac ICU admissions receive respiratory support with associated increased mortality. These data provide benchmarks for quality improvement ventures in the cardiac ICU, inform cardiac critical care training and staffing patterns, and serve as foundation for future studies aimed at improving outcomes.

  View details for DOI 10.1097/CCE.0000000000000182

  View details for PubMedID 33235999

• DIETARY PROTEIN INTAKE AND INCIDENT ATRIAL FIBRILLATION IN POSTMENOPAUSAL WOMEN FROM THE WOMEN'S HEALTH INITIATIVE Gerber, D. A., Stefanick, M., Hlatky, M., Yang, J., Hedlin, H., Haring, B., Perez, M. ELSEVIER SCIENCE INC. 2020

  View details for Web of Science ID 000520890600006

• Structural Abnormalities on Cardiac Magnetic Resonance Imaging in Patients With Catecholaminergic Polymorphic Ventricular Tachycardia. JACC. Clinical electrophysiology Gerber, D. A., Dubin, A. M., Ceresnak, S. R., Motonaga, K. S., Bussineau, M. n., Dunn, K. n., Caleshu, C. n., Shoemaker, M. B., Lubitz, S. A., Perez, M. V. 2020; 6 (6): 741–42

  View details for DOI 10.1016/j.jacep.2020.03.006

  View details for PubMedID 32553227

• Clinical Practice Patterns in Temporary Mechanical Circulatory Support for Shock in the Critical Care Cardiology Trials Network (CCCTN) Registry. Circulation. Heart failure Berg, D. D., Barnett, C. F., Kenigsberg, B. B., Papolos, A., Alviar, C. L., Baird-Zars, V. M., Barsness, G. W., Bohula, E. A., Brennan, J., Burke, J. A., Carnicelli, A. P., Chaudhry, S., Cremer, P. C., Daniels, L. B., DeFilippis, A. P., Gerber, D. A., Granger, C. B., Hollenberg, S., Horowitz, J. M., Gladden, J. D., Katz, J. N., Keeley, E. C., Keller, N., Kontos, M. C., Lawler, P. R., Menon, V., Metkus, T. S., Miller, P. E., Nativi-Nicolau, J., Newby, L. K., Park, J., Phreaner, N., Roswell, R. O., Schulman, S. P., Sinha, S. S., Snell, R. J., Solomon, M. A., Teuteberg, J. J., Tymchak, W., van Diepen, S., Morrow, D. A. 2019; 12 (11): e006635

  Abstract

  BACKGROUND: Temporary mechanical circulatory support (MCS) devices provide hemodynamic assistance for shock refractory to pharmacological treatment. Most registries have focused on single devices or specific etiologies of shock, limiting data regarding overall practice patterns with temporary MCS in cardiac intensive care units.METHODS: The CCCTN (Critical Care Cardiology Trials Network) is a multicenter network of tertiary CICUs in North America. Between September 2017 and September 2018, each center (n=16) contributed a 2-month snapshot of consecutive medical CICU admissions.RESULTS: Of the 270 admissions using temporary MCS, 33% had acute myocardial infarction-related cardiogenic shock (CS), 31% had CS not related to acute myocardial infarction, 11% had mixed shock, and 22% had an indication other than shock. Among all 585 admissions with CS or mixed shock, 34% used temporary MCS during the CICU stay with substantial variation between centers (range: 17%-50%). The most common temporary MCS devices were intraaortic balloon pumps (72%), Impella (17%), and veno-arterial extracorporeal membrane oxygenation (11%), although intraaortic balloon pump use also varied between centers (range: 40%-100%). Patients managed with intraaortic balloon pump versus other forms of MCS (advanced MCS) had lower Sequential Organ Failure Assessment scores and less severe metabolic derangements. Illness severity was similar at high- versus low-MCS utilizing centers and at centers with more advanced MCS use.CONCLUSIONS: There is wide variation in the use of temporary MCS among patients with shock in tertiary CICUs. While hospital-level variation in temporary MCS device selection is not explained by differences in illness severity, patient-level variation appears to be related, at least in part, to illness severity.

  View details for DOI 10.1161/CIRCHEARTFAILURE.119.006635

  View details for PubMedID 31707801

• RECURRENT SYNCOPE IN A YOUNG PATIENT: FROM A SIMPLE OUTPATIENT BIOPSY TO BRUGADA SYNDROME AND A DEFIBRILLATOR Hospital Medicine Gerber, D. A., Filsuf, D., Moraff, A., Soorajbally, K., Kalra, P., Rohatgi, N. 2019
• Occult Structural Disease in Patients With Catecholaminergic Polymorphic Ventricular Tachycardia Gerber, D. A., Dubin, A. M., Ceresnak, S. R., Motonaga, K. S., Dunn, K., Caleshu, C., Smith, A., Jackson, M., Perez, M. V. LIPPINCOTT WILLIAMS & WILKINS. 2016

  View details for Web of Science ID 000396816608109

• First case of infectious endocarditis caused by Parvimonas micra. Anaerobe Gomez, C. A., Gerber, D. A., Zambrano, E., Banaei, N., Deresinski, S., Blackburn, B. G. 2015; 36: 53-55

  Abstract

  P. micra is an anaerobic Gram-positive cocci, and a known commensal organism of the human oral cavity and gastrointestinal tract. Although it has been classically described in association with endodontic disease and peritonsillar infection, recent reports have highlighted the role of P. micra as the primary pathogen in the setting of invasive infections. In its most recent taxonomic classification, P. micra has never been reported causing infectious endocarditis in humans. Here, we describe a 71 year-old man who developed severe native valve endocarditis complicated by aortic valvular destruction and perivalvular abscess, requiring emergent surgical intervention. Molecular sequencing enabled identification of P. micra.

  View details for DOI 10.1016/j.anaerobe.2015.10.007

  View details for PubMedID 26485192