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Is There EVER a Role for Veno-Venous ECMO (VV-ECMO) in the Emergency Department?
Here is a case of a young man who presented to our Emergency Department in June, 2106 with profound anaphylaxis. This was a rare “CAN Intubate/CAN'T VENTILATE” scenario:
- Max Epinephrine
- Max antihistamines
- Max steroids
- Max ventilator
…and you still cannot ventilate. PaCO2 is going up. pH is going down.
What options do you have? Find out in this episode.
Here is the video produced by Sharp Memorial Hospital (@SharpHealthcare) about this case:
Special thanks to:
Kevin Shaw MD
Intensive Care
Sharp Memorial Hospital
Andrew Eads MD
Emergency Medicine
Sharp Memorial Hospital
Melissa Brunsvold MD
Department of Surgery
University of Minnesota
Conrad Soriano
Brynn Shinar
Cutest Girl on Earth
Joe is an ED Invasivist who endorses any procedure looking for an indication.
Zack is an ER doctor who enjoys a particular fondness for bringing people back from the dead. 
Scott is an ED Intensivist (whatever that means) who likes to talk to himself.
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6 Comments on "EDECMO 31 – Anaphylaxis & Epi-Pens. Are we ready for VV-ECMO in the Emergency Department?"
Phil-
Amazing to have you here reading/listening to the edecmo stuff. Ever care to come on the show?
–Scott
Agreed. Your precautions are right on, as is Joe’s explanation. This patient has unusual anatomy with very thick, leathery skin in the groin. After ECMO initiation, I did end up placing femoral arterial and venous lines for access, and had a tremendous amount of difficulty despite a very nice ultrasound machine.
With the retrospectascope in use, my approach would have been different. At the time, I had no ability to use TEE or fluoroscopy. If in the exact same circumstance again, I would recommend serial CXR with ultrasound of the IVC.
so sorry.
just read all the comments below, which more than answer my questions. (i think). still wonder if VV fem/fem wouldn’t just steal all the good blood just returned. i guess you’d need to place the tip of the cannula removing the blood several cm’s away from the tip of the cannula returning , but which more distal? i suspect the returning port should be more proximal, since you would want the returning blood closer to vital organs (?).