Episode 3 – Who the HELL do we put on ECMO during Arrest?

Who Gets ECPR and Who Doesn’t?

Great question! This may be the hardest question we deal with when a patient arrives and ECPR is a consideration.

This episode is broken down into three parts:

  1. Who exactly do we consider an appropriate candidate for ECPR?
  2. TOR = Termination of Resuscitation in the pre-hospital arena and why we HATE it!
  3. Pre-hospital ECPR – REALLY?

 

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15 Comments on "Episode 3 – Who the HELL do we put on ECMO during Arrest?"

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Mike
Guest
1. Love this podcast! Keep up the good work. 2. Once we have a better handle on who will most likely benefit from ECPR we can identify whom to “stay and play” with and whom to “load and go.” 3. We need to figure out what “load and go means.” It probably doesn’t make sense to scoop up a fresh arrest and run them down to the ambulance because ECMO is only for patients who fail ACLS. We have to give good ol’ CPR and defib a chance! Scooping and running immediately would cause an unacceptable delay in CPR. Furthermore,… Read more »
EMCrit
Admin

Mike, the best example of how this functions is the Alfred hospital in Australia in the course of Stephen Bernard’s Cheer trial. They got a LUCAS machines for EMS allowing immediate movement to the bus.

Scott L
Guest

As a current critical care transport nurse on the helicopter, you say that lots of places are trasnporting ECMO, Is this being done by ground or air? Also, of the programs actually flying ECMO patients in the US at this time I would love to hear about the type of aircraft and configuration of the flight crews etc.
Thanks you for the great educational site and podcasts , I look forward to learning more.

Thomas D
Guest
Thanks for another great episode! I love how you’re up-front on the issues of starting out a program like this. That it needs tight inclusion criteria and pretty wide exclusion criteria to get success to get the program up and running. To prove to yourselves and management that it works. On the stay-and-play/load-and-go debate, going out to the patient sounds exciting, but I’m more a fan of bringing them in. It seems to take some time to put them on pump, and the patient might need additional treatment in that time frame. For transport, this is what the LUCAS was… Read more »
Thomas D
Guest

PS. I can’t really find the show notes?

Mike
Guest
In British Columbia we operate a HEMS Bell 412 out of Kamloops with Critical Care Paramedics. We have moved one ECMO patient by air from Kelowna to Vancouver (1.5 hrs) this past year and one by road from the eastern part of the province to Kelowna (5 hrs) in which we brought ECMO to the patient. The layout in the 412 does provide for this type of transport albeit it’s very tight. The team at KGH has a transport ECMO unit and we are currently working with our colleagues there to address the specialized transport needs and requirements to better… Read more »
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