The ED ECMO boys are speaking at Essentials of Emergency Medicine in San Francisco!

Zack, Joe and Scott will be doing a whole morning this year at the 2014 Essentials of Emergency Medicine in San Francisco November 7-10 at the Marriott Marquis. And Weingart is mediating!  We are doing some really cool stuff on “EXTREME RESUSCITATION!”  Take a look at the itinerary below:

 

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This is THE premier conference for Emergency Medicine and Critical Care specialists.  We have no disclosures regarding this conference except to say that it TOTALLY ROCKS!

Register for this conference now!

See you there!

NEW! Mobile-optimized version of www.edecmo.org

Weingart designed the NEW mobile version of our site!  Navigate to the site via any mobile device (iPhone, Android, etc) and check it out! There's even an audio player embedded so podcast episodes can be streamed directly to your device.

 

Better yet, use any scanning app and scan the www.edecmo.org custom barcode, using your mobile device, and you'll be taken right to the mobile-optimized site: QR

 

 

Don't have a scanner app on your device?  I recommend the following FREE scanning apps:

iphone/iPad: QR reader, QR Code Scanner and Reader, or Quick Scan

Android: QR Reader or QR Code Reader

The Resuscitation Cart

Zack and I have talked a lot about the “Resuscitation Cart”.  Here is our Resuscitation Cart 2.0 which was just overhauled.  This cart has almost everything we use during resuscitations in our ED and gets brought to the bedside for every code or crashing patient.

For non-ECPR cases, the only additional equipment needed are your crash cart, ultrasound machine, RSI equipment, and (optional) your mechanical chest compression device.  EVERYTHING else is on this cart including IV ACCESS, IO, Rescue Airway supplies, etc.

For ECPR cases we use the above items in addition to the ECMO cart (contents checklist previously posted) and the ECMO machine.

Resuscitation Cart

Resuscitation Cart

Drawer 1

Drawer 2

Drawer 3

Drawer 4

Drawer 5

Side Bins

 

 

 

 

The Resuscitation Cart

The Resuscitation CartResuscitation Cart Inventory April 2014

 

***special thanks to Melody Shedlosky RN for assistance with establishing the SMH resuscitation cart.

 

The www.edecmo.org QR barcode

use any QR scanner app on your iPhone or Android to scan the www.edecmo.org QR barcode.

save the image and send to your friends and colleagues to share the goodness…

QR

The Sharp Memorial Hospital ECMO Equipment Checklists

Our ECMO cart checklist and femoral artery cutdown checklist were added to the “ECLS EQUIPMENT” section of the edecmo.org website. Check them out!

How to Set-up a Pressure Transducer

Joe asked me to cross-post this video here from the EMCrit Site. Every doc and nurse should be able to set one of these up in <2 minutes for rapid arterial and central venous pressure monitoring.

 

Steven Bernard on the CHEER Trial from Intensive Care Network

The amazing blog and podcast: Intensive Care Network run by Oli Flower and Matt Mac Partlin recorded this lecture by Steven Bernard talking about the CHEER Trial of ECPR.

Dr. Bernard's Slides

Now on to the Lecture…

ECMO Powerpoints from Velia Marta Antonini

Velia Marta Antonini is an ICU Nurse and ECMO Specialist in Parma Italy (Follow her on Twitter). She has some amazing slide presentations on ECMO. Hopefully, we'll interview her for the podcast in the coming months.

Part I – Indications and Configurations


 

Part II – The ECMO Circuit


 

Part III – ECMO Complications


 

Part IV – Monitoring and Nursing

 

First Prehospital-ECMO Initiation Abstract Just Published

My friend Bri Burns sent me this abstract this morning:

Thorac cardiovasc Surg 2013; 61 – P45 (DOI: 10.1055/s-0032-1332685)

Pre-hospital cardiopulmonary resuscitation supported by ECMO – a case series of 6 patients

M Hilker, A Philip, M Arlt, M Amann, D Lunz, T Müller, M Zimmermann, B Graf , C Schmid

  • Universitätsklinikum Regensburg, Regensburg, Germany

Objectives: Manual cardiopulmonary resuscitation (CPR) or automated CPR with chest compression systems are currently the standard treatments for cardiac arrest patients out of the hospital. There is a strong clinical evidence that rapid onset of ECMO in patients with cardiocirculatory failure can improve survival during in-hospital resuscitation. In contrast to these findings out-of-hospital cardiac arrest patients cannulated in the emergency room show a poor outcome.

Our aim is to shorten the „time-to-pump“ by initiation of the ECMO system on scene with safe transportation under stable hemodynamics. Therefore this case series of 6 patients demonstrate our first “real life” experience with this approach.

Methods: In the last two years (from September 2010 to 2012), ECMO was installed in 6 patients on scene by an interdisciplinary team. All patients who met the following citeria were included. 1. witnessed cardiac arrest; 2. refractory cardiac arrest; 3. a mobile ECMO team was available; 5. a lack of known, severe comorbidities; 6. age < 70 years.

Results: The results are subsumed in the following table.

Table 1: Patient data and Outcome
case years, gender location of ECMO implantation time to pump (min) diagnosis subsequet intervention outcome
1 11, f swimming lake 50 drowning CT dead, global brain ischemia
2 44, f apartment 90 PE CT dead, global brain ischemia
3 50, m doctor's office 55 AMI PCI, CT dead, global brain ischemia
4 53, m apartment 53 PE none dead on scene
5 52, m apartment 67 AMI DCI, CT persistent neurological deficit
6 57, m place of work 50 AMI PCI, CT alive without deficit

Conclusion: To the best of our knowledge, this is the first case series that shows not only the feasibility of implantation of ECMO on scene for refractory cardiac arrest but also the successful application of this approach. The holy grail is now to identify patients in advance who will suffer irreversible cerebral anoxia.

Hot off the press: Chest Compressions are Probably Safe for LVAD patients

Shinar/Bellezzo paper:

Our most recent paper, Chest compressions may be safe in arresting patients with left ventricular assist devices (LVADs), has just been accepted for publication in the journal Resuscitation.  This paper is the largest known review of patients with LVAD's who arrest.  Our best evidence suggests that it is safe to do chest compressions in LVAD patients. Chest compressions don't appear to dislodge the VAD. Besides, the patient is going to die anyway!

By the way, the most common cause of arrest in these patients is ACCIDENTAL DISCONNECTION of both battery supplies! So if you get the call from the radio nurse with an LVAD patient that has arrested: 1. start chest compressions…it appears to be safe and 2. find a power supply or spare batteries!

Here is the abstract:

 

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