Podcast: Play in new window | Download (Duration: 23:09 — 19.1MB)
Subscribe: RSS
“Normal life is changing. It is now a covid 19 life” – Bin Cao
I write this with some trepidation as well as pride in the role we all get to play in Covid 19. The sure in the US and many other places worldwide is just beginning. It is on us to seek guidance from those who have gone through this already. Today we will address the use of ECMO in Covid with an expert in ECMO who is in the throws of the worst outbreak of the United States – Seattle, Washington. Jenelle Badulak and I give you a short yet powerful discussion about what Covid patients should receive ECMO.
Take homes for decision to initiate- comorbidities (HTN, DM especially), single organ dysfunction, young age, trajectory of course
Hosts – Jenelle Badulak, Zack Shinar
ECMO guidance for Coronavirus
- MERS ECMO Data
- Alshahrani MS, Sindi A, Alshamsi F, Al-Omari A, El Tahan M, Alahmadi B, Zein A, Khatani N, Al-Hameed F, Alamri S, Abdelzaher M, Alghamdi A, Alfousan F, Tash A, Tashkandi W, Alraddadi R, Lewis K, Badawee M, Arabi YM, Fan E, Alhazzani W. Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus. Ann Intensive Care. 2018 Jan 10;8(1):3. doi: 10.1186/s13613-017-0350-x. PubMed PMID: 29330690; PubMed Central PMCID: PMC5768582
- Chinese Society of Extracorporeal Life Support. [Recommendations on extracorporeal life support for critically ill patients with novel coronavirus pneumonia]. Zhonghua Jie He He Hu Xi Za Zhi. 2020 Feb 9;43(0):E009. doi: 10.3760/cma.j.issn.1001-0939.2020.0009. [Epub ahead of print] Chinese. PubMed PMID: 32035430.
- http://rs.yiigle.com/yufabiao/1180132.htm
- Inclusion criteria under this paper are–>
- Under optimal ventilation conditions (FiO 2 ≥ 0.8, tidal volume 6 ml / kg, PEEP ≥ 10 cmH 2 O), ECMO can be started if there are no contraindications and one of the following conditions is met [ 7 , 8 , 14 , 16 , 17 , 18 ] : (1) PaO 2 / FiO 2 <50 mmHg for more than 3 h; (2) PaO 2 / FiO 2 <80 mmHg for more than 6 h; (3) FiO 2 = 1.0, PaO 2 / FiO 2 <100 mmHg; (4) Arterial blood pH <7.25 and PaCO 2 > 60 mmHg for more than 6 hours, and respiratory rate> 35 times / min; (5) When respiratory rate> 35 times / min, blood pH <7.2 The plateau pressure was> 30 cmH 2 O; (6) severe air leak syndrome; (7) combined with cardiogenic shock or cardiac arrest.
- Good overall webinar – ECMO considerations start – http://iv.docbook.com.cn/record/app-name/46020/2020-03-19-20-45-14_2020-03-19-21-40-14.mp4
- ELSO Guidance Document
We’ve had some recent episodes on ECMO physiology. Today’s episode focuses on the differences between ECMO physiology in the patient in cardiogenic shock versus the one in cardiac arrest. Scott Weingart talks with Zack about how the difference between these two patient populations is HUGE! Scott also mentions details about cannulation and some critical post ECMO initiation pearls.
The U.S. has seen pre-hospital programs spring up in Paris, UK, and Australia. It 
was thought that due to billing issues this could never happen in America….but it has. Jon Marinaro and Darren Braude have accomplished this against all odds. Zack interviews the two of them on how they were able to accomplish this task amidst the many financial, logistic, and medical problems surrounding this monumental task.
Over the last several years, data has suggested that partial or intermittent REBOA may have benefit over complete REBOA. How to do this and how to use our current imperfect catheters in this arena is still in question. Dr. Matthew Martin and his colleagues at Madigan Medical Center have published the first study using Prytime’s new catheter for partial REBOA. Zack interviews Matt in this episode about this latest paper in Journal of Trauma and Acute Surgery as well as several other papers he’s published in the field. Dr. Martin is extensively published in the field and offers his insight in the specific flows that maximize survival within the conflicting problems of hemorrhagic shock and lower body ischemia.
Do you give heparin to your ECMO patients? Well, let’s rethink this. This episode is All Things Anticoagulation! Zack talks with Troy Seelhammer, an intensivist from Mayo Clinic Rochester. He manages ECMO patients in his daily practice there. He has become a master of the subject of anticoagulation and if you’re interested in other medicines you can visit a 
In this episode, Sacha Richardson talks with Zack about a problem common to all ECPR programs- how do we confirm the placement of the wires? During chest compressions and even in patients with a pulse, confirmation of which vessel you have cannulated can be difficult. Sacha shares some tricks and trips on how to get real time confirmation of the wires. Sacha also gives us a preview of some of the exciting endeavors that he has undertaken in Melbourne with pre-hospital ECMO.
