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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
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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
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excellent pod, guys. thank you.
tom
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!
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.