In this episode, Jon Marinaro and Zack Shinar go through the hot off the press Inception trial. The trial was touted as a negative ECPR study though many reasons make this trial different then the ARREST trial. They go through several important take home points for practitioners starting or running an ECPR/ECMO program.
[Read more]
In this podcast, Joe Tonna tells us how to approach hypothermia with ECPR patients. He also goes through his paper RESCUE-IHCA giving us an immediate way to prognosticate in patients to use of ECMO or not.
Hypothermia – Resuscitation
Nakashima T, Ogata S, Noguchi T, Nishimura K, Hsu CH, Sefa N, Haas NL, Bĕlohlávek J, Pellegrino V, Tonna JE, Haft J, Neumar RW. Association of intentional cooling, achieved temperature and hypothermia duration with in-hospital mortality in patients treated with extracorporeal cardiopulmonary resuscitation: An analysis of the ELSO registry. Resuscitation. 2022 Aug;177:43-51. doi: 10.1016/j.resuscitation.2022.06.022. Epub 2022 Jul 3. PMID: 35788020.
Hypothermia Meta-Analysis
Duan J, Ma Q, Zhu C, Shi Y, Duan B. eCPR Combined With Therapeutic Hypothermia Could Improve Survival and Neurologic Outcomes for Patients With Cardiac Arrest: A Meta-Analysis. Front Cardiovasc Med. 2021 Aug 13;8:703567. doi: 10.3389/fcvm.2021.703567. PMID: 34485403; PMCID: PMC8414549.
In Hospital Cardiac Arrest and ECPR Inclusion
Tonna JE, Selzman CH, Girotra S, Presson AP, Thiagarajan RR, Becker LB, Zhang C, Rycus P, Keenan HT; American Heart Association Get With the Guidelines–Resuscitation Investigators. Resuscitation Using ECPR During In-Hospital Cardiac Arrest (RESCUE-IHCA) Mortality Prediction Score and External Validation. JACC Cardiovasc Interv. 2022 Feb 14;15(3):237-247. doi: 10.1016/j.jcin.2021.09.032. Epub 2022 Jan 12. PMID: 35033471; PMCID: PMC8837656.
[Read more]
In this episode, Zack interviews Florian Schmitzberger who just published a fantastic study that incorporates fourteen leaders within the ECPR community to hash out the specific procedural steps associated with ECPR.
[Read more]
This month Zack gives a few pearls from the recent Reanimate courses and annual ELSO meeting in Boston before he interviews Gawry Mork from Aarhus University about her fantastic recent paper.
Pearl #1 is about hand placement in cannulation. Hold the ultrasound in your left an
d needle in right. Once in the vessel, drop the US probe and take your left hand and gently hold the needle. With your right hand grab the wire far enough up to be to insert into the vessel in one push.
Gawry’s paper has many interesting points. Probably the biggest is the reasonable survivorship for prolonger arrests. This is tied to equality of care for patient who live far from the closest ECMO center.
This month we are honored to have Neville Vlok on the show. Neville has been one of the key physicians pushing for ECPR in South Africa. In this episode, we explore what medicine and resuscitation looks like in South Africa, how ECMO has been utilized, and whether ECMO even makes sense in developing countries.
Vlok N, Hedding KA, Van Dyk MA. Saved by the pump: Two successful resuscitations utilising emergency department-initiated extracorporeal cardiopulmonary resuscitation in South Africa. S Afr Med J. 2021 Mar 2;111(3):208-210. doi: 10.7196/SAMJ.2021.v111i3.15366. PMID: 33944740.
[Read more]
Using ECMO for traumatic patients has had some promising papers through the years, but the data overall is still poor. Justyna Swol has teamed up with ELSO to improve this deficiency by making a trauma carve out of the ELSO registry. In this episode, Zack discusses with Justyna the many facets of ECMO in trauma. A few pearls and references are below:
Anticoagulation in ECMO is not mandatory. A reasonable strategy is heparinized circuit with a titrating dose of systemic heparin as necessary in the trauma patient. This includes everyone from isolated pulmonary contusions to intracranial hemorrhage.
VV-ECMO similar to ARDS in medical causes can be used and likely offers survival benefit to those patients with post traumatic lung injury. Initiating early (maybe PaO2 of 80 on 100% FiO2) is likely best.
ECPR can be done in the traumatic arrest. Best when done in parallel to the other resuscitative needs of the patient. Data is promising in case series. Need for bigger data sets is clear.
The Netherlands has undertaken a monumental task: provide ECPR to 100% of their country. Dinis Reis Miranda and his team have put in place an unbelievably organized and robust project to improve the survival from cardiac arrest for their entire country. Listen to Dinis explain about the project, their struggles, and this world changing experiment going on right now in Netherlands.
Here is their projects website and some of its content – https://onscenetrial.com/
[Read more]
In this short episode, Zack makes two points. One, it was tough to get to where we are with ECMO acceptance. Two, cardiac arrest patients in PEA should be considered for ECPR. Below is the full editorial Zack and Alice did recently in the Journal of Resuscitation on the topic. It was born out of a fantastic German article centered looking at registry outcomes for PE and ECMO.
Full Free Link to Editorial (until January 2022) – https://authors.elsevier.com/a/1eAXK_6ryqqpRd
Article link – https://www.resuscitationjournal.com/article/S0300-9572(21)00403-2/fulltext
[Read more]
Have you ever pondered whether all the work over ECPR was worth it? Even if you did save a few patients, does this really make sense from a societal standpoint? Am I giving up my life on a project where my efforts could be better elsewhere? Then this episode is for you (and me). This month I talk with Melissa Barnes and Ryan Coute about the economics of cardiac arrest and specifically ECPR. Ryan has just published a great paper in Resuscitation on the costs on OHCA. We will talk with Ryan and Melissa Barnes, ECMO manager at Sharp Memorial Hospital about benefits and costs to society of OHCA and ECMO. I learned several pearls from Ryan’s paper as well as a paper by Grosse that Ryan references. Below are the links to both papers with a couple graphs to try to wrap your head around.
[Read more]
Crew, We are proud to announce the world’s first ECPR textbook. We partnered with ELSO and 25 of the world’s leaders in ECPR and resuscitative ECMO to create an awesome resource for both in depth learning and on shift quick reference. Click the hyperlink for Ebook or Hardcover
[Read more]