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In this episode Jon Marinaro joins the ED ECMO team and interviews his colleague Sundeep Guliani, MD about the use of an ECMO first strategy for Massive Pulmonary Embolism. Jon and Sundeep review the data and processes from their institution and from other institutions in the United States. Could it be that ECLS could move the survival needle on this high mortality disease? Listen and find out!
Hobohm L, Sagoschen I, Habertheuer A, Barco S, Valerio L, Wild J, Schmidt FP,
Gori T, Münzel T, Konstantinides S, Keller K. Clinical use and outcome of
extracorporeal membrane oxygenation in patients with pulmonary embolism.
Resuscitation. 2022 Jan;170:285-292. doi: 10.1016/j.resuscitation.2021.10.007.
Epub 2021 Oct 12. PMID: 34653550.
Shinar Z, Hutin A. Pulmonary ECMO-ism: Let’s add PEA to ECPR indications.
Resuscitation. 2022 Jan;170:293-294. doi: 10.1016/j.resuscitation.2021.11.004.
Epub 2021 Nov 10. PMID: 34774708.
Pudil J, Rob D, Smalcova J, Smid O, Huptych M, Vesela M, Kovarnik T,
Belohlavek J. Pulmonary embolism related refractory out-of-hospital cardiac
arrest and extracorporeal cardiopulmonary resuscitation: Prague OHCA study post-
hoc analysis. Eur Heart J Acute Cardiovasc Care. 2023 May 12:zuad052. doi:
10.1093/ehjacc/zuad052. Epub ahead of print. PMID: 37172033.
Karami M, Mandigers L, Miranda DDR, Rietdijk WJR, Binnekade JM, Knijn DCM,
Lagrand WK, den Uil CA, Henriques JPS, Vlaar APJ; DUTCH ECLS Study Group.
Survival of patients with acute pulmonary embolism treated with venoarterial
extracorporeal membrane oxygenation: A systematic review and meta-analysis. J
Crit Care. 2021 Aug;64:245-254. doi: 10.1016/j.jcrc.2021.03.006. Epub 2021 Mar
24. PMID: 34049258.
Hello,
thanks for your great talk! For us its a big thing actually! I am a emergency physician in Freiburg, Germany. We try to get the ECMO to the patient – per car, so it is not an option in the most cases! When we can bring the ECMO to the patient it is more easy to decide to do a lysis after or before the ecmo, when you have all information.
But when the prehospital team has to transport the patient, there are two problems: Give lysis in arrest or periarrest and could this be a problem later, when there are complications on ecmo, especially bleedings? Should you use mechanial CPR systems after lysis, when we know they can do a lot of damage and so bleeding complications? But without mechanical cpr transport is nearly impossible! And do you have knowledge for reduced doses of lysis? Are the outcomes equal with less bleedings?
How do you manage this questions and patients?
Best regards
Sebastian