Pericardial Tamponade just before tap + ECPR
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Based on a voicemail message we received from Justin Cook, an Emergency Physician out of Portland, Oregon, this episode focuses on the cognitive task analysis of using ultrasound during ECPR.
When your patient hits the door with CPR in progress, what is your ultrasound priority? Diagnostics? Ultrasound-guided line placement? This episode of the EDECMO podcast attempts to answer that question.
This is a snapshot of a patient we discussed who presented with tearing chest pain and arrested with HR 180 narrow-complex. pericardial tamponade relieved with drain placed by Bellezzo. Still no pulses. We put him on ECMO and he was taken to the OR: he had back-dissected into his AV. After ECMO the patient was taken to the OR where his AV was resuspended and the ascending aorta grafted. He left the hospital neuro-intact. In this case, diagnostic US took precedence over line placement. But this is a caveat to the usual rule that US-guided line placement is most urgent.
And here is a video clip of the tamponade:
dissection video from Joe Bellezzo on Vimeo.
Thanks for listening!
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Great point about placing patient on backboard for easier femoral access. From my personal experience it’s always been easier gaining femoral access in trauma patients compared to cardiac arrest or medical patients, I could never quite figure out why….now I know.
Ari, We actually do do this! We usually use the smaller CPR board and put it behind the pelvis. I gotta give credit to Frank Kennedy, our Chief of Trauma, for originally bringing this tip to us a couple years ago.