In this episode, Zack interviews Jim Manning MD (University of North Carolina) and Dr. Lionel Lamhaut of the famed French SAMU (Service d'Aide Médicale Urgente).
2015 Resuscitation Science Symposium updates:
“ECMO is at the forefront of resuscitation science” – Jim Manning
The New REBOA Catheter: Pryor Medical – just obtained FDA approval for endovascular proximal control of non-compressible hemorrhage below the diaphragm.
At Sharp Memorial Hospital we currently use the 12Fr Chek-Flo sheath, paired with 12F (external diameter) CODA balloon occlusion catheter for non-compressible hemorrhage below the diaphragm. Pryor Medical has just gained FDA approval to market their REBOA catheter – a 7F version that doesn't seem to require surgical repair of the arteriotomy site. For those of us doing REBOA, this is a BIG DEAL:
Selective Aortic Arch Perfusion Catheter (SAAP) – which is like a REBOA catheter but has a lumen large enough to perfuse blood (or a blood substitute) through. Manning talks about what's sexy with his device.
Lionel Lamhaut from the French SAMU (Service d'Aide Médicale Urgente) gives us an update on their prehospital ECMO program in France:
SAMU Inclusion Criteria:
- Medical Cardiac Arrest
- Age < 75
- No Flow < 5 min (bystander CPR must be started within 5 min)
- Hypothermia is always considered
- Intoxications (of any kind) are always considered
- ETCO2 > 10
For review, check out our original discussion with ‘reanimateur' Dr. Lamhaut about prehospital ECMO: edecmo.org/17
In keeping with all of the in-hospital and out-of-hospital ECPR data accumulating, it appears that Lamhaut's team is also seeing a success rate (survival with CPC 1 or 2) of around 30% (final data pending publication).
Consider this: the modified cut-down technique. The French prehospital team, quite obviously, don't have ultrasound access in the field. So instead of using ultrasound visualization of the femoral vessels, they necessarily use direct visualization. Listen to this episode to hear the details…