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73b: Conclusions for Hyperinvasive Trial with Jan Belohlavek

https://media.blubrry.com/edecmo/p/traffic.libsyn.com/secure/edecmo/73b.mp3Podcast: Play in new window | Download (Duration: 5:09 — 4.1MB)Subscribe: Apple Podcasts | RSSHere is the conclusion for the interview of Jan Belohlavek and his Hyperinvasive Trial

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73:The Hyperinvasive Trial with Jan Belohlavek

Wait…ECPR works?

To the believers, this has been a foregone conclusion.  To the rest of the world, the question of whether ECPR improves cardiac arrest survivorship has been in question. Jan Belohlavek and his Prague colleagues just presented their 8 year data showing better outcomes in cardiac arrest patients that got a grouped therapy of early transport, prehospital hypothermia, mechanical chest compressions, and ECMO over those who got a traditional resuscitation.  This study is key and contrasts to the Oslo study that we reviewed just a few months earlier.  Jan speaks with Zack about the details of the results and what were the keys to their success.

Hyperinvasive trial study proposal – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3492121/

Jan’s slides on Hyperinvasive Results

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72: Should We All Switch To Bivalirudin?

Heparin has been the mainstay of anticoagulation for ECMO patients for years.  In recent years, this has been challenged.  Bivalirudin has b
ecome a potential better anticoagulant.  Troy Seelhammer in EDECMO episode 55 gave us some insight into this.  This month Ryan Rivosecchi and his crew at UPitt have released their findings in Critical Care Medicine.  This retrospective study suggests great improvement in major bleeding in patients who received Bivalirudin compare to Heparin (40.7% vs 11.7%, p < 0.001).  Listen to Ryan and Zack discuss anticoagulant use in ECMO patients in this month's episode. Rivosecchi RM, Arakelians AR, Ryan J, Murray H, Padmanabhan R, Gomez H, Phillips D, Sciortino C, Arlia P, Freeman D, Sappington PL, Sanchez PG. Comparison of Anticoagulation Strategies in Patients Requiring Venovenous Extracorporeal Membrane Oxygenation: Heparin Versus Bivalirudin. Crit Care Med. 2021 Mar 15. doi: 10.1097/CCM.0000000000004944. Epub ahead of print. PMID: 33711003. .

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71: Should We Prioritize VV-ECMO over ECPR?

In this episode, we dive into the abyss of resource allocation.  Much of the world is saying that the limited number of ECMO circuits should be used for COVID induced lung injury.  This means that ECPR initiatives have been shut down or severely limited.  Is this the right thing to do?  What does the data say?  What strategy gives the most benefit to the most people?  Zack invited Brian Grunau to discuss these topics as well as a recent ECPR paper out of Norway and study dealing with signs of life during CPR.

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70: REBOA REDUX – Management of Hemorrhagic Shock in Non-Trauma Patients – with Bellezzo & Zaf Qasim

In this episode Joe Bellezzo talks with Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) expert Zaf Qasim about NON-TRAUMA applications of aortic compression for control of non-compressible non-trauma torso hemorrhage. 

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69: 2020 Synopsis

2020 was a crazy year.  This month Zack goes through the biggest ECMO lessons learned in 2020.  This is a short concise run through of ECPR, ECMO for COVID, Imaging, and Aortic Dissection.  It’s a reminder of how organization is so critical to the outcome of your ECMO program.  He also reminds us how improvement in these systems of care can lead to survival rates even the believers in ECMO thought were unattainable.

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68: ARREST – The First Randomized ECPR Trial Ever

The ARREST Trial is published!  Demetris Yannopoulos, Jason Bartos and their army of rockstars have done it!  This is the first randomized ECPR trial and it showed tremendous benefit of ECPR compared to traditional therapies.  Zack explores this paper and their concurrent publication of process with Demetris.   Their two Lancet papers are below

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32338-2/fulltext
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30376-X/fulltext

In the news, Jenelle Badulak and her crew at UW saved a hypothermic mountaineer in Seattle.  Story here.

https://www.bbc.com/news/world-us-canada-54959874

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67: Da DO2: Fundamental ECMO Physiology with Sage Whitmore

Have you ever wondered about how initiating ECMO changes the cardiovascular physiology?  Have you wondered what metrics you should be looking at when resuscitating a patient that has a beating heart and a ECMO flow?  Dr. Sage Whitmore, an ED Intensivist from Nashville with ECMO training from UMichigan, leads us through the basic to the tough questions of ECMO physiology.  Zack Shinar

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66: Crash VV ECMO

Have you ever wondered how you would crash someone onto VV ECMO?  Have you ever wondered where is the best place to put the cannulas?  Have stayed up late at night wondering which patients in your department could benefit from VV rather than VA ECMO?  Then this is the episode for you!!  After a few recent cases of crash VV ECMO in our hospital, we have decided to focus on the subject.  Zack gets critical care physician David Willms to answer from a very practical standpoint the who, what, where of crash VVECMO.

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65: ECPR Journal Club: Dual Sequential Defibrillation, CT after ECMO, and much, much more

This month we tackle a number of topics.  Garrett Sterling is back again with Zack Shinar to talk about cutting edge resuscitation, ECMO, and the interplay between the two.  Dual sequential defibrillation, CT after ECMO initiation, should you perform bystander CPR in the era of Covid, some US ECMO data, and an awesome 3D modeling for ECPR training models.  All in one 30 minute podcast!

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