In this episode, Zack talks with Heidi Dalton about ECMO use in Sepsis. This is another controversial area with pediatric literature showing strong results while the adult results have been less impressive. Heidi has been a key figure in both adult and pediatric ECMO. She is the former chair of the yearly ELSO conference. She is a professor at both George Washington University and Virginia Commonwealth University. Her background is in pediatric critical care. She currently works at INOVA in Virginia where she is the director of adult and pediatric ECMO.
Sepsis has been thought to be a contraindication to ECMO use secondary to the pro-inflammatory nature of ECMO and potential to harbor infection. Recent research is certainly controversial with adult studies showing low survival in septic shock and sepsis as a cause of arrest. As with much of ECMO literature, the problem is with the denominator – What is the expected survival of these patients? The follow up question becomes what effort is prudent for these low survival rates? The sepsis cohort tend to be younger and potential for long term survival is high. The question remains should we be utilizing ECMO for sepsis?1–9