64: Contraindicated??? – Long Live the Aortic Dissection with Garrett Sterling

Aortic Dissection is a contraindication for ECMO….or is it?  In this episode, Zack Shinar and Garrett Sterling discuss the sticky topic of ECMO for aortic dissection.  They discuss a recent case where Joe Bellezzo, Karl Limmer, Craig Larsen, and the entire Sharp team save a Type A aortic dissection with cardiac arrest.

Zack and Garrett traverse the details around ECMO in aortic dissection ranging from VA ECMO in ECPR to VVECMO for pulmonary edema.  They go through the literature on the subject and make some conclusions based on this data. The ultimate question – “Is Aortic Dissection a Contraindication for ECMO?”

Joe's interview of Michael – Great to hear his memory of the event.

Michael's podcast on his experience – The Heart of the Matter

 

 

Hou XT, Sun YQ, Zhang HJ, Zheng SH, Liu YY, Wang JG. Femoral artery

cannulation in Stanford type A aortic dissection operations. Asian Cardiovasc

Thorac Ann. 2006 Feb;14(1):35-7. PubMed PMID: 16432116.

 

Kelly C, Ockerse P, Glotzbach JP, Jedick R, Carlberg M, Skaggs J, Morgan DE.

Transesophageal echocardiography identification of aortic dissection during

cardiac arrest and cessation of ECMO initiation. Am J Emerg Med. 2019

Jun;37(6):1214.e5-1214.e6. doi: 10.1016/j.ajem.2019.02.039. Epub 2019 Feb 27.

PubMed PMID: 30862393.

 

Yukawa T, Sugiyama K, Miyazaki K, Tanabe T, Ishikawa S, Hamabe Y. Treatment of

a patient with acute aortic dissection using extracorporeal cardiopulmonary

resuscitation after an out-of-hospital cardiac arrest: a case report. Acute Med

Surg. 2017 Dec 19;5(2):189-193. doi: 10.1002/ams2.324. eCollection 2018 Apr.

PubMed PMID: 29657734; PubMed Central PMCID: PMC5891112

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tom fiero
tom fiero
1 year ago

excellent pod, guys. thank you.

tom

Byron Mendenhall MD
Byron Mendenhall MD
4 months ago

Gotta say who ever was doing the anesthesia needs to be recognized for doing a phenomenal job in getting this guy off the table! Jus’ sayin!

Byron Mendenhall MD
Byron Mendenhall MD
4 months ago

VA ECMO increases the LV afterload and the severity of any pre-existing aortic regurgitation will worsen. The LV will dilate leading to pulmonary edema and risk of subendocardial ischemia secondary to increased myocardial oxygen consumption and wall stress. VA ECMO in a case like this with a totally incompetent Aortic valve would probably not have been the right call. VV ECMO was the right choice.

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