Dr. Gerber is a critical care cardiologist and co-director of Stanford's Cardiac ICU. He has dual subspecialty training in cardiovascular and critical care medicine and additional board certification in echocardiography. He completed his residency in internal medicine, fellowship in cardiovascular medicine, and an additional fellowship in critical care medicine at Stanford University and joined as faculty in 2021 as a Clinical Assistant Professor in the Department of Medicine’s Division of Cardiovascular Medicine.
Dr. Gerber manages the full spectrum of heart and vascular conditions with a focus on critically ill patients with life-threatening cardiovascular disease. He is active in medical education, teaching introductory echocardiography to Stanford medical students and residents, co-directing the Stanford Critical Care Medicine Critical Care Ultrasound Program, and lecturing nationally on critical care echocardiography and point-of-care ultrasonography at the Society of Critical Care Medicine’s annual congress. Finally, Dr. Gerber’s research interests focus on optimizing cardiac intensive care, including working with the Critical Care Cardiology Trials Network (CCCTN) - a national network of tertiary cardiac ICUs coordinated by the TIMI Study Group - and studying acute mechanical circulatory support techniques to improve patient outcomes and care processes.
- Cardiovascular Disease
- Critical Care Cardiology
- Critical Care Medicine
- Cardiogenic Shock
- Mechanical Circulatory Support
- Point-of-Care Ultrasonography
Clinical Assistant Professor, Department of Medicine, Divisions of Cardiovascular & Critical Care Medicine (2021 - Present)
Honors & Awards
Faculty Speaker, American Thoracic Society: Critical Care Ultrasound & Echocardiography (2022)
Faculty Speaker, Society of Critical Care Medicine: Advanced Critical Care Ultrasound Course (2022)
Faculty Speaker, Society of Critical Care Medicine: Advanced Critical Care Ultrasound Course (2021)
Featured Abstract Press Promotion, American College of Cardiology/World Congress of Cardiology ACC.20/WCC (2020)
Timothy F. Beckett, Jr. Award for Best Clinical Teaching by a Medicine Fellow, Stanford University School of Medicine (2019)
Recipient, Yale/Stanford Johnson & Johnson Global Health Scholarship (2017)
Invited Speaker, World Economic Forum Global Shapers: Medical Innovation (2016)
Recipient, Sheikh Zayed Institute Student Innovator Program
Recipient, Tauber Holocaust Memorial Scholarship
College Park Scholar, University of Maryland
Boards, Advisory Committees, Professional Organizations
Member, Society of Critical Care Medicine (2021 - Present)
Member, American College of Cardiology (2017 - Present)
Member, American Heart Association (2016 - Present)
Member, American College of Physicians (2014 - Present)
Board Certification: National Board of Echocardiography, Adult Echocardiography (2019)
Board Certification: American Board of Internal Medicine, Critical Care Medicine (2021)
Board Certification, American Board of Internal Medicine, Critical Care Medicine (2021)
Fellowship: Stanford University Critical Care Medicine Fellowship (2021) CA
Board Certification: American Board of Internal Medicine, Cardiovascular Disease (2020)
Fellowship: Stanford University Cardiovascular Medicine Fellowship (2020) CA
Board Certification: American Board of Internal Medicine, Internal Medicine (2017)
Residency: Stanford University Internal Medicine Residency (2017) CA
Medical Education: George Washington University Office of the Registrar (2014) DC
Residency, Stanford University Medical Center, Internal Medicine (2017)
Internship, Stanford University Medical Center, Internal Medicine (2015)
MD, George Washington University, School of Medicine (2014)
BS, University of Maryland, Physiology & Neurobiology (2010)
Prognostic Significance of Hemodynamic Parameters in Patients with Cardiogenic Shock.
European heart journal. Acute cardiovascular care
Invasive hemodynamic assessment with a pulmonary artery catheter is often used to guide management of patients with cardiogenic shock (CS) and may provide important prognostic information. We aimed to assess prognostic associations and relationships to end-organ dysfunction of presenting hemodynamic parameters in CS.The Critical Care Cardiology Trials Network (CCCTN) is an investigator-initiated multicenter registry of cardiac intensive care units (CICUs) in North America coordinated by the TIMI Study Group. Patients with CS (2018-2022) who underwent invasive hemodynamic assessment within 24 hours of CICU admission were included. Associations of hemodynamic parameters with in-hospital mortality were assessed using logistic regression, and associations with presenting serum lactate were assessed using least squares means regression. Sensitivity analyses were performed excluding patients on temporary mechanical circulatory support and adjusted for vasoactive-inotropic score.Among the 3,603 admissions with CS, 1,473 had hemodynamic data collected within 24 hours of CICU admission. Median cardiac index was 1.9 (IQR, 1.6-2.4) L/min/m2 and mean arterial pressure (MAP) was 74 (66-86) mmHg. Parameters associated with mortality included low MAP, low systolic blood pressure, low systemic vascular resistance, elevated right atrial pressure (RAP), elevated RAP/pulmonary capillary wedge pressure ratio, and low pulmonary artery pulsatility index. These associations were generally consistent when controlling for intensity of background pharmacologic and mechanical hemodynamic support. These parameters were also associated with higher presenting serum lactate.In a contemporary CS population, presenting hemodynamic parameters reflecting decreased systemic arterial tone and indicators of right ventricular dysfunction are associated with adverse outcomes and presenting lactate.
View details for DOI 10.1093/ehjacc/zuad095
View details for PubMedID 37640029
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).
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
2021; 27 (10): 1073-1081
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
2021; 78 (13): 1309-1317
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
2020; 2 (9): e0182
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
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 2020; 6 (6): 741–42
Clinical Practice Patterns in Temporary Mechanical Circulatory Support for Shock in the Critical Care Cardiology Trials Network (CCCTN) Registry.
Circulation. Heart failure
2019; 12 (11): e006635
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 2019
Occult Structural Disease in Patients With Catecholaminergic Polymorphic Ventricular Tachycardia
LIPPINCOTT WILLIAMS & WILKINS. 2016
View details for Web of Science ID 000396816608109
First case of infectious endocarditis caused by Parvimonas micra.
2015; 36: 53-55
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