ED ECMO https://edecmo.org Resuscitationist-Initiated Extracorporeal Life Support Thu, 06 Dec 2018 04:38:52 +0000 en-US hourly 1 https://wordpress.org/?v=4.9.8 EDECMO.org is a non-commercial source to discover the life-saving potential of resuscitative extra-corporeal membrane oxygenation (ecmo) and extra-corporeal life support (ecls). We will teach you the skills and break down the logistics to allow resuscitationists to initiate ECMO in the ED or ICU. the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart edecmo@gmail.com edecmo@gmail.com (the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart) EDECMO 2013 Resuscitative ECMO, ECLS, and ECPR ED ECMO https://edecmo.org/wp-content/uploads/powerpress/edecmo-art-individual-podcast.jpg https://edecmo.org 55190668 50b Inter-Facility Transport of ECMO patients Part 2 of 2 https://edecmo.org/50b-inter-facility-transport-of-ecmo-patients-part-2-of-2/ Wed, 05 Dec 2018 22:20:14 +0000 https://edecmo.org/?p=4377 https://edecmo.org/50b-inter-facility-transport-of-ecmo-patients-part-2-of-2/#comments https://edecmo.org/50b-inter-facility-transport-of-ecmo-patients-part-2-of-2/feed/ 1 <p>This is part 2 of Transport of ECMO patients.  Mikael Broman is one of the world's leaders on ECMO transport.  He works at the Karolinska institute in Sweden and has and continues to publish in the arena of ECMO transport.  As you will see, he offers a world of experience and certainly some critical information that we would all benefit from listening to.  I'm a smarter ECMO-tologist as a result of Micke!</p> <p>The post <a rel="nofollow" href="https://edecmo.org/50b-inter-facility-transport-of-ecmo-patients-part-2-of-2/">50b Inter-Facility Transport of ECMO patients Part 2 of 2</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p> This is part 2 of Transport of ECMO patients.  Mikael Broman is one of the world's leaders on ECMO transport.  He works at the Karolinska institute in Sweden and ha

s and continues to publish in the arena of ECMO transport.  As you will see, he offers a world of experience and certainly some critical information that we would all benefit from listening to.  I'm a smarter ECMO-tologist as a result of Micke!1234

 

 

 

 

ELSO transport guidelines -https://www. elso.org/Portals/0/Files/ELSO%20GUIDELINES%20 FOR%20ECMO%20TRANSPORT_May2015.pdf

 

1.
Bryner B, Cooley E, Copenhaver W, et al. Two Decades’ Experience With Interfacility Transport on Extracorporeal Membrane Oxygenation. T. 2014;98(4):1363-1370. doi:10.1016/j.athoracsur.2014.06.025
2.
Javidfar J, Brodie D, Takayama H, et al. Safe Transport of Critically Ill Adult Patients on Extracorporeal Membrane Oxygenation Support to a Regional Extracorporeal Membrane Oxygenation Center. A. 2011;57(5):421-425. doi:10.1097/mat.0b013e3182238b55
3.
Broman LM. Inter-hospital transports on extracorporeal membrane oxygenation in different health-care systems. J. 2017;9(9):3425-3429. doi:10.21037/jtd.2017.07.93
4.
Ericsson A, Frenckner B, Broman L. Adverse Events during Inter-Hospital Transports on Extracorporeal Membrane Oxygenation. Prehosp Emerg Care. 2017;21(4):448-455. [PubMed]

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This is part 2 of Transport of ECMO patients.  Mikael Broman is one of the world's leaders on ECMO transport.  He works at the Karolinska institute in Sweden and has and continues to publish in the arena of ECMO transport.  As you will see, This is part 2 of Transport of ECMO patients.  Mikael Broman is one of the world's leaders on ECMO transport.  He works at the Karolinska institute in Sweden and has and continues to publish in the arena of ECMO transport.  As you will see, he offers a world of experience and certainly some critical information that we would all benefit from listening to.  I'm a smarter ECMO-tologist as a result of Micke! the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 48:14 4377
50a Inter-facility Transport of ECMO patients Part 1 of 2 https://edecmo.org/50a-inter-facility-transport-of-ecmo-patients-part-1-of-2/ Wed, 05 Dec 2018 20:29:30 +0000 https://edecmo.org/?p=4327 https://edecmo.org/50a-inter-facility-transport-of-ecmo-patients-part-1-of-2/#respond https://edecmo.org/50a-inter-facility-transport-of-ecmo-patients-part-1-of-2/feed/ 0 <p>This month we are looking at how to transport patients from one facility to another on ECMO.  This is difficult task full of potential catastrophes.  Zack interviews Leon Eydelman, an ER/Critical Care physician from Chicago, and Michael Broman out of Karolinska in Sweden.  Leon will be bringing us up to speed on what to do, potential fails, and how to start the process of setting up a transport process for ECMO patients.  Dr. Eydelman will be teaching a new section at Reanimate this January specifically geared toward the transport of patients.  So if you are a nurse, medic, perfusionist, RT, or physician involved in the transport of ECMO patients you will not want to miss Leon's section  Sign up at Reanimateconference.com.  Part 2 of this podcast includes the interview with Dr. Broman which will blow your mind.  So much great stuff in both of these interviews.</p> <p>The post <a rel="nofollow" href="https://edecmo.org/50a-inter-facility-transport-of-ecmo-patients-part-1-of-2/">50a Inter-facility Transport of ECMO patients Part 1 of 2</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p>

This month we are looking at how to transport patients from one facility to another on ECMO.  This is a difficult task, full of potential catastrophes.  Zack interviews Leon Eydelman, an ER/Critical Care physician from Chicago, and Michael Broman out of Karolinska in Sweden.  Leon will be bringing us up to speed on what to do, potential fails, and how to start the process of setting up a transport process for ECMO patients.  Dr. Eydelman will be teaching a new section at Reanimate this January specifically geared toward the transport of patients.  So if you are a nurse, medic, perfusionist, or RT involved in the transport of ECMO patients you will not want to miss Leon's section  Sign up at Reanimateconference.com.  Part 2 of this podcast includes the interview with Dr. Broman which will blow your mind.  So much great stuff in both of these interviews.

The post 50a Inter-facility Transport of ECMO patients Part 1 of 2 appeared first on ED ECMO.

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This month we are looking at how to transport patients from one facility to another on ECMO.  This is difficult task full of potential catastrophes.  Zack interviews Leon Eydelman, an ER/Critical Care physician from Chicago, This month we are looking at how to transport patients from one facility to another on ECMO.  This is difficult task full of potential catastrophes.  Zack interviews Leon Eydelman, an ER/Critical Care physician from Chicago, and Michael Broman out of Karolinska in Sweden.  Leon will be bringing us up to speed on what to do, potential fails, and how to start the process of setting up a transport process for ECMO patients.  Dr. Eydelman will be teaching a new section at Reanimate this January specifically geared toward the transport of patients.  So if you are a nurse, medic, perfusionist, RT, or physician involved in the transport of ECMO patients you will not want to miss Leon's section  Sign up at Reanimateconference.com.  Part 2 of this podcast includes the interview with Dr. Broman which will blow your mind.  So much great stuff in both of these interviews. the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 22:42 4327
49 – You Can’t Spell REBOA without the ER – Endovascular Resuscitation of the Trauma Patient – Zaf Qasim https://edecmo.org/49-you-cant-spell-reboa-without-the-er-endovascular-resuscitation-of-the-trauma-patient-zaf-qasim/ Fri, 12 Oct 2018 14:27:38 +0000 https://edecmo.org/?p=4234 https://edecmo.org/49-you-cant-spell-reboa-without-the-er-endovascular-resuscitation-of-the-trauma-patient-zaf-qasim/#respond https://edecmo.org/49-you-cant-spell-reboa-without-the-er-endovascular-resuscitation-of-the-trauma-patient-zaf-qasim/feed/ 0 <p>n this episode, Zack Shinar interviews Zaf Qasim about the recent controversies with ACEP and ACS about who can do REBOA.  Zaf is one of the world's experts on REBOA and he's an ER doc!  Zaf works at the University of Pennsylvania, trained in London</p> <p>as well as Shock Trauma in Baltimore and teaches at Reanimate.  When you come to the essence of this episode, the question is what is the emergency physician's role in the trauma resuscitation?  Both Zaf and Zack agree; we need to be the resuscitationist in the trauma suite.  We need to manage the airway and then quickly take over the arterial and venous access, interpret the transduced pressures, manage the massive transfusion protocol and be ready to insert the REBOA catheter while the trauma surgeon is involved with the left chest, the source of bleeding and where the next destination for this patient will be.</p> <p>The post <a rel="nofollow" href="https://edecmo.org/49-you-cant-spell-reboa-without-the-er-endovascular-resuscitation-of-the-trauma-patient-zaf-qasim/">49 – You Can’t Spell REBOA without the ER – Endovascular Resuscitation of the Trauma Patient – Zaf Qasim</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p>

In this episode, Zack Shinar interviews Zaf Qasim about the recent controversies with ACEP and ACS about who can do REBOA.  Zaf is one of the world's experts on REBOA and he's an ER doc!  Zaf works at the University of Pennsylvania, trained in London

as well as Shock Trauma in Baltimore and teaches at Reanimate.  When you come to the essence of this episode, the question is what is the emergency physician's role in the trauma resuscitation?  Both Zaf and Zack agree; we need to be the resuscitationist in the trauma suite.  We need to manage the airway and then quickly take over the arterial and venous access, interpret the transduced pressures, manage the massive transfusion protocol and be ready to insert the REBOA catheter while the trauma surgeon is involved with the left chest, the source of bleeding and where the next destination for this patient will be.

The post 49 – You Can’t Spell REBOA without the ER – Endovascular Resuscitation of the Trauma Patient – Zaf Qasim appeared first on ED ECMO.

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n this episode, Zack Shinar interviews Zaf Qasim about the recent controversies with ACEP and ACS about who can do REBOA.  Zaf is one of the world's experts on REBOA and he's an ER doc!  Zaf works at the University of Pennsylvania, trained in London n this episode, Zack Shinar interviews Zaf Qasim about the recent controversies with ACEP and ACS about who can do REBOA.  Zaf is one of the world's experts on REBOA and he's an ER doc!  Zaf works at the University of Pennsylvania, trained in London<br /> <br /> as well as Shock Trauma in Baltimore and teaches at Reanimate.  When you come to the essence of this episode, the question is what is the emergency physician's role in the trauma resuscitation?  Both Zaf and Zack agree; we need to be the resuscitationist in the trauma suite.  We need to manage the airway and then quickly take over the arterial and venous access, interpret the transduced pressures, manage the massive transfusion protocol and be ready to insert the REBOA catheter while the trauma surgeon is involved with the left chest, the source of bleeding and where the next destination for this patient will be. the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 27:07 4234
EDECMO 48: When Should I Transport a Cardiac Arrest? https://edecmo.org/edecmo-48-when-should-i-transport-a-cardiac-arrest/ Fri, 10 Aug 2018 12:14:51 +0000 https://edecmo.org/?p=4149 https://edecmo.org/edecmo-48-when-should-i-transport-a-cardiac-arrest/#respond https://edecmo.org/edecmo-48-when-should-i-transport-a-cardiac-arrest/feed/ 0 <p>This part two of August 2018.  We are now tackling the difficult question of when to transport cardiac arrests if I have ECMO available?  Brian Grunau is an expert in this question.  Brian has become a giant in the world of ECMO.  His research, leadership and experience have pushed the Canadian ECPR contingency to the forefront.   Brian gives us some insight on what factors I should consider and when should I transport.</p> <p>The post <a rel="nofollow" href="https://edecmo.org/edecmo-48-when-should-i-transport-a-cardiac-arrest/">EDECMO 48: When Should I Transport a Cardiac Arrest?</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p> This part two of August 2018.  We are now tackling the difficult question of when to transport cardiac arrests if I have ECMO available?  Brian Grunau is an expert in this question.  Brian has become a giant in the world of ECMO.  His research, leadership and experience have pushed the Canadian ECPR contingency to the forefront.   Brian gives us some insight on what factors I should consider and when should I transport.1

1.
Grunau B, Reynolds J, Scheuermeyer F, et al. Relationship between Time-to-ROSC and Survival in Out-of-hospital Cardiac Arrest ECPR Candidates: When is the Best Time to Consider Transport to Hospital? P. 2016;20(5):615-622. doi:10.3109/10903127.2016.1149652

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This part two of August 2018.  We are now tackling the difficult question of when to transport cardiac arrests if I have ECMO available?  Brian Grunau is an expert in this question.  Brian has become a giant in the world of ECMO.  His research, This part two of August 2018.  We are now tackling the difficult question of when to transport cardiac arrests if I have ECMO available?  Brian Grunau is an expert in this question.  Brian has become a giant in the world of ECMO.  His research, leadership and experience have pushed the Canadian ECPR contingency to the forefront.   Brian gives us some insight on what factors I should consider and when should I transport. the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 35:13 4149
EDECMO 47: ECMO Donazione: Organ Transplantation with Velia Antonini https://edecmo.org/edecmo-47-ecmo-donazione-organ-transplantation-with-velia-antonini/ Sat, 04 Aug 2018 20:04:50 +0000 https://edecmo.org/?p=4139 https://edecmo.org/edecmo-47-ecmo-donazione-organ-transplantation-with-velia-antonini/#respond https://edecmo.org/edecmo-47-ecmo-donazione-organ-transplantation-with-velia-antonini/feed/ 0 <p>Over this last year we have had episodes on organ donation and decision to transport.  This month we are revisiting two topics with two amazing people in two separate episodes.  Here, I interviewed Velia Marta Antonini.   Velia works in Italy where several of the great ECMO donation papers have originated.  She explains why this research is coming from Italy, what the process looks like, and the implications of this for other countries.  Check out her slides below.</p> <p>The post <a rel="nofollow" href="https://edecmo.org/edecmo-47-ecmo-donazione-organ-transplantation-with-velia-antonini/">EDECMO 47: ECMO Donazione: Organ Transplantation with Velia Antonini</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p> Over this last year we have had episodes on organ donation and decision to transport.  This month we are revisiting two topics with two amazing people in two separate episodes.  Here, I interviewed Velia Marta Antonini.   Velia works in Italy where several of the great ECMO donation papers have originated.  She explains why this research is coming from Italy, what the process looks like, and the implications of this for other countries.  Check out her slides below.

 

 

 

Here are Velia's slides on the subject

eisor ED ecmo (1)

 

 

 

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Over this last year we have had episodes on organ donation and decision to transport.  This month we are revisiting two topics with two amazing people in two separate episodes.  Here, I interviewed Velia Marta Antonini. Over this last year we have had episodes on organ donation and decision to transport.  This month we are revisiting two topics with two amazing people in two separate episodes.  Here, I interviewed Velia Marta Antonini.   Velia works in Italy where several of the great ECMO donation papers have originated.  She explains why this research is coming from Italy, what the process looks like, and the implications of this for other countries.  Check out her slides below. the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 15:35 4139
EDECMO 46: Wire Assistant https://edecmo.org/edecmo-46-wire-assistant/ Fri, 06 Jul 2018 02:21:25 +0000 https://edecmo.org/?p=4117 https://edecmo.org/edecmo-46-wire-assistant/#respond https://edecmo.org/edecmo-46-wire-assistant/feed/ 0 <p>Well, it only took us seven years to figure this one out.  The wire assistant has been the key advancement of 2018 for placement of ECMO cannulas.  In this episode, Zack and Joe talk through this process after an  interview with Alyssa Baldini.  Alyssa was one of our first true wire assistants and has been instrumental in getting cannulas in faster and safer.  We discuss how the wire assistant aids in sterility and getting the artery on the first stick.  Bottom line - train someone at your shop to be an expert wire assistant.</p> <p>The post <a rel="nofollow" href="https://edecmo.org/edecmo-46-wire-assistant/">EDECMO 46: Wire Assistant</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p> Well, it only took us seven years to figure this one out.  The wire assistant has been the key advancement of 2018 for placement of ECMO cannulas.  In this episode, Zack and Joe talk through this process after an  interview with Alyssa Baldini.  Alyssa was one of our first true wire assistants and has been instrumental in getting cannulas in faster and safer.  We discuss how the wire assistant aids in sterility and getting the artery on the first stick.  Bottom line – train someone at your shop to be an expert wire assistant.

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Well, it only took us seven years to figure this one out.  The wire assistant has been the key advancement of 2018 for placement of ECMO cannulas.  In this episode, Zack and Joe talk through this process after an  interview with Alyssa Baldini. Well, it only took us seven years to figure this one out.  The wire assistant has been the key advancement of 2018 for placement of ECMO cannulas.  In this episode, Zack and Joe talk through this process after an  interview with Alyssa Baldini.  Alyssa was one of our first true wire assistants and has been instrumental in getting cannulas in faster and safer.  We discuss how the wire assistant aids in sterility and getting the artery on the first stick.  Bottom line - train someone at your shop to be an expert wire assistant. the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 25:25 4117
EDECMO 45: ECMO in Sepsis https://edecmo.org/edecmo-45-ecmo-for-sepsis/ Thu, 10 May 2018 23:12:25 +0000 https://edecmo.org/?p=4023 https://edecmo.org/edecmo-45-ecmo-for-sepsis/#respond https://edecmo.org/edecmo-45-ecmo-for-sepsis/feed/ 0 <p>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. So the question for today is should we be utilizing ECMO for sepsis? </p> <p>The post <a rel="nofollow" href="https://edecmo.org/edecmo-45-ecmo-for-sepsis/">EDECMO 45: ECMO in Sepsis</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p>

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

1.
Maclaren G, Butt W, Best D, Donath S, Taylor A. Extracorporeal membrane oxygenation for refractory septic shock in children: one institution’s experience. Pediatr Crit Care Med. 2007;8(5):447-451. [PubMed]
2.
Datzmann T, Träger K. Extracorporeal membrane oxygenation and cytokine adsorption. J. 2018;10(S5):S653-S660. doi:10.21037/jtd.2017.10.128
3.
Perdue SM, Poore BJ, Babu AN, Stribling WK. Successful use of extracorporeal membrane oxygenation support in severe septic shock with associated acute cardiomyopathy. J. 2018;33(1):50-52. doi:10.1111/jocs.13508
4.
von Bahr V, Hultman J, Eksborg S, Frenckner B, Kalzén H. Long-Term Survival in Adults Treated With Extracorporeal Membrane Oxygenation for Respiratory Failure and Sepsis*. C. 2017;45(2):164-170. doi:10.1097/ccm.0000000000002078
5.
Millar J, Fanning J, McDonald C, McAuley D, Fraser J. The inflammatory response to extracorporeal membrane oxygenation (ECMO): a review of the pathophysiology. Crit Care. 2016;20(1):387. [PubMed]
6.
Choi M, Ha S, Kim H, Park S, Han S, Lee S. The Simplified Acute Physiology Score II as a Predictor of Mortality in Patients Who Underwent Extracorporeal Membrane Oxygenation for Septic Shock. Ann Thorac Surg. 2017;103(4):1246-1253. [PubMed]
7.
Tramm R, Ilic D, Davies A, Pellegrino V, Romero L, Hodgson C. Extracorporeal membrane oxygenation for critically ill adults. Cochrane Database Syst Rev. 2015;1:CD010381. [PubMed]
8.
Park T, Yang J, Jeon K, et al. Extracorporeal membrane oxygenation for refractory septic shock in adults. Eur J Cardiothorac Surg. 2015;47(2):e68-74. [PubMed]
9.
Sharma A, Weerwind P, Maessen J. Extracorporeal membrane oxygenation resuscitation in adult patients with refractory septic shock. J Thorac Cardiovasc Surg. 2014;147(4):1441-1442. [PubMed]

The post EDECMO 45: ECMO in Sepsis appeared first on ED ECMO.

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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. 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. So the question for today is should we be utilizing ECMO for sepsis? the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 31:02 4023
EDECMO Crash Episode – Demetris Yannopoulos on ECPR-the Minneapolis Way https://edecmo.org/demetris-yannopoulos-on-ecpr-the-minneapolis-way/ Sun, 08 Apr 2018 18:49:11 +0000 https://edecmo.org/?p=3965 https://edecmo.org/demetris-yannopoulos-on-ecpr-the-minneapolis-way/#comments https://edecmo.org/demetris-yannopoulos-on-ecpr-the-minneapolis-way/feed/ 4 <p>Yanno on ECPR</p> <p>The post <a rel="nofollow" href="https://edecmo.org/demetris-yannopoulos-on-ecpr-the-minneapolis-way/">EDECMO Crash Episode – Demetris Yannopoulos on ECPR-the Minneapolis Way</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p>

We do an EDECMO ECPR course each year called REANIMATE. REANIMATE5 blew away all previous iterations. One of the main reasons was our guest of honor, Demetris Yannopoulos from the University of Minnesota. Demetris has organized Minneapolis into arguably the most impressive ECPR city in the world. We were lucky enough to be able to film his Sharp Hospital Grand Rounds. This lecture was mind-blowing and made us so jealous. We think you will love it.

Tickets are on Sale for REANIMATE6

Additional Info/Resources

 

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Yanno on ECPR Yanno on ECPR the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 1:18:47 yes 3965
EDECMO 44: Bob Bartlett: Peristaltic Pumps, Hollow Fibers, and the History of ECMO https://edecmo.org/edecmo-44-bob-bartlett-peristaltic-pumps-hollow-fibers-history-ecmo/ Thu, 22 Mar 2018 00:12:26 +0000 https://edecmo.org/?p=3900 https://edecmo.org/edecmo-44-bob-bartlett-peristaltic-pumps-hollow-fibers-history-ecmo/#comments https://edecmo.org/edecmo-44-bob-bartlett-peristaltic-pumps-hollow-fibers-history-ecmo/feed/ 1 <p>In this episode, Zack interviews Bob Bartlett from the University of Michigan.  He is truly the godfather of ECMO and has revolutionized the world with his leadership and innovation.  They discuss the history of ECMO and roller pumps and bubble oxygenators were clearly inferior to their current counterparts - centrifugal pumps and hollow fiber oxygenators.  They also discuss anticoagulation and how Bob feels direct thrombin inhibitors are superior.  They also discuss the future of ECMO and how peristaltic pumps may be where we are headed.  </p> <p>The post <a rel="nofollow" href="https://edecmo.org/edecmo-44-bob-bartlett-peristaltic-pumps-hollow-fibers-history-ecmo/">EDECMO 44: Bob Bartlett: Peristaltic Pumps, Hollow Fibers, and the History of ECMO</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p> 1

In this episode, Zack Shinar interviews Dr. Bob Bartlett from the University of Michigan.  Dr. Bartlett has revolutionized the world with his leadership and innovation from the very beginnings of ECMO.  Zack and Bob discuss the history of ECMO and the prior use of roller pumps and bubble oxygenators.  They go on to describe the advantages of centrifugal pumps and hollow fiber oxygenators.  Additionally, they talk about PMP (polymethylpentene)-coated membranes inside oxygenators and their improved ability to safely oxygenate blood.  They discuss anticoagulation and how Bob believes that direct thrombin inhibitors are superior.  They wrap it up with a discussion on the future of ECMO and how peristaltic pumps have some significant advantages2.

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3,4

1.
Perchinsky M, Long W, Hill J, Parsons J, Bennett J. Extracorporeal cardiopulmonary life support with heparin-bonded circuitry in the resuscitation of massively injured trauma patients. Am J Surg. 1995;169(5):488-491. [PubMed]
2.
Bartlett RH. Esperanza. A. 2017;63(6):832-843. doi:10.1097/mat.0000000000000697
3.
Ali AA, Downey P, Singh G, et al. Rat model of veno-arterial extracorporeal membrane oxygenation. J. 2014;12(1):37. doi:10.1186/1479-5876-12-37
4.
Spurlock DJ, Raney DN, Fracz EM, Mazur DE, Bartlet RH, Haft JW. In Vitro Testing of a Novel Blood Pump Designed for Temporary Extracorporeal Support. A. February 2012:1. doi:10.1097/mat.0b013e318245d356

The post EDECMO 44: Bob Bartlett: Peristaltic Pumps, Hollow Fibers, and the History of ECMO appeared first on ED ECMO.

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In this episode, Zack interviews Bob Bartlett from the University of Michigan.  He is truly the godfather of ECMO and has revolutionized the world with his leadership and innovation.  They discuss the history of ECMO and roller pumps and bubble oxygena... In this episode, Zack interviews Bob Bartlett from the University of Michigan.  He is truly the godfather of ECMO and has revolutionized the world with his leadership and innovation.  They discuss the history of ECMO and roller pumps and bubble oxygenators were clearly inferior to their current counterparts - centrifugal pumps and hollow fiber oxygenators.  They also discuss anticoagulation and how Bob feels direct thrombin inhibitors are superior.  They also discuss the future of ECMO and how peristaltic pumps may be where we are headed.   the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 36:58 3900
EDECMO 43: The Cutdown https://edecmo.org/edecmo-43-cutdown/ Tue, 20 Feb 2018 17:06:35 +0000 https://edecmo.org/?p=3781 https://edecmo.org/edecmo-43-cutdown/#comments https://edecmo.org/edecmo-43-cutdown/feed/ 1 <p>In this episode,  Alice Hutin of the Paris SAMU talks about the modified cutdown approach to cannula insertion.  She is an emergency physician who is one of four physicians who take call on the pre-hospital ECMO ambulance.  She describes the process of their modified cutdown.  First, incision through the skin is made 2 cm below inguinal crease.  Second, blunt dissection down through the soft tissue.  This is best done with your fingers.  Third, place a needle through the distal skin and visualize it pass into the vessel.  From there, you cannulate as with percutaneous.  Alice’s recent paper shows a 6% failure rate with this technique in skilled hands.</p> <p>The post <a rel="nofollow" href="https://edecmo.org/edecmo-43-cutdown/">EDECMO 43: The Cutdown</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p> The Cutdown Approach to ECMO Cannula Insertion with Alice Hutin, Lionel Lamhaut, and Zack Shinar

In this episode,  Alice Hutin of the Paris SAMU talks about the modified cutdown approach to cannula insertion.  She is an emergency physician who is one of four physicians who cannulates on the pre-hospital ECMO ambulance.  She describes the process of their modified cutdown.  We are holding off on written descriptions and pictures of the procedure pending Alice's publication so you will just have to listen!!!! We'll post the pictures soon!  Until then, here is a youtube segment showing a femoral cutdown -https://www.youtube.com/watch?v=zzu7cU3YoXo

 

Another recent publication by Alice:

Hutin A, Lamhaut L, Lidouren F, Kohlhauer M, Mongardon N, Carli P, Berdeaux A, Ghaleh B, Tissier R. Early Coronary Reperfusion Facilitates Return of Spontaneous Circulation and Improves Cardiovascular Outcomes After Ischemic Cardiac Arrest and Extracorporeal Resuscitation in Pigs. J Am Heart Assoc. 2016 Dec 22;5(12). pii: e004588. doi: 1. PubMed PMID: 28007740; PubMed Central PMCID: PMC5210433

1.
Hutin A, Lamhaut L, Lidouren F, et al. Early Coronary Reperfusion Facilitates Return of Spontaneous Circulation and Improves Cardiovascular Outcomes After Ischemic Cardiac Arrest and Extracorporeal Resuscitation in Pigs. J. 2016;5(12):e004588. doi:10.1161/jaha.116.004588

The post EDECMO 43: The Cutdown appeared first on ED ECMO.

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In this episode,  Alice Hutin of the Paris SAMU talks about the modified cutdown approach to cannula insertion.  She is an emergency physician who is one of four physicians who take call on the pre-hospital ECMO ambulance. In this episode,  Alice Hutin of the Paris SAMU talks about the modified cutdown approach to cannula insertion.  She is an emergency physician who is one of four physicians who take call on the pre-hospital ECMO ambulance.  She describes the process of their modified cutdown.  First, incision through the skin is made 2 cm below inguinal crease.  Second, blunt dissection down through the soft tissue.  This is best done with your fingers.  Third, place a needle through the distal skin and visualize it pass into the vessel.  From there, you cannulate as with percutaneous.  Alice’s recent paper shows a 6% failure rate with this technique in skilled hands. the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 29:49 3781
EDECMO 42: Organ Transplantation On ECMO https://edecmo.org/edecmo-42-organ-transplantation-ecmo/ Tue, 16 Jan 2018 16:19:12 +0000 https://edecmo.org/?p=3746 https://edecmo.org/edecmo-42-organ-transplantation-ecmo/#comments https://edecmo.org/edecmo-42-organ-transplantation-ecmo/feed/ 2 <p>In this episode, we tackle the subject of organ transplantation on ECMO.  2017 featured several articles showing the efficacy of ECMO for organ transplantation.  In Italy, 56% of total potential patients were successfully transplanted.  The success of these transplants have been comparable to patients not on ECMO.  Zack Shinar interviews Lionel Lamhaut, ECMO specialist from […]</p> <p>The post <a rel="nofollow" href="https://edecmo.org/edecmo-42-organ-transplantation-ecmo/">EDECMO 42: Organ Transplantation On ECMO</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p>

In this episode, we tackle the subject of organ transplantation on ECMO.  2017 featured several articles showing the efficacy of ECMO for organ transplantation.  In Italy, 56% of total potential patients were successfully transplanted.  The success of these transplants have been comparable to patients not on ECMO.  Zack Shinar interviews Lionel Lamhaut, ECMO specialist from Paris, and Cyrus Olsen, ethicist from the University of Scranton, to dive into some of the deeper questions including financial implications, ethical angles, and research extrapolations.  Join Zack, Lionel and Cy at Big Sick 18 (bigsick18.org) in Zermatt Switzerland on February 7-9th,, 2018!!

 

1: Christopher DA, Woodside KJ. Expanding the Donor Pool: Organ Donation After
Brain Death for Extracorporeal Membrane Oxygenation Patients. Crit Care Med. 2017
Oct;45(10):1790-1791. doi: 10.1097/CCM.0000000000002633. PubMed PMID: 28915178.

2: Bronchard R, Durand L, Legeai C, Cohen J, Guerrini P, Bastien O. Brain-Dead
Donors on Extracorporeal Membrane Oxygenation. Crit Care Med. 2017
Oct;45(10):1734-1741. doi: 10.1097/CCM.0000000000002564. PubMed PMID: 28640022.

3: Casadio MC, Coppo A, Vargiolu A, Villa J, Rota M, Avalli L, Citerio G. Organ
donation in cardiac arrest patients treated with extracorporeal CPR: A single
centre observational study. Resuscitation. 2017 Sep;118:133-139. doi:
10.1016/j.resuscitation.2017.06.001. Epub 2017 Jun 12. PubMed PMID: 28596083.

4: Dalle Ave AL, Bernat JL. Donation after brain circulation determination of
death. BMC Med Ethics. 2017 Feb 23;18(1):15. doi: 10.1186/s12910-017-0173-1.
PubMed PMID: 28228145; PubMed Central PMCID: PMC5322624.

5: Larsson M, Forsman P, Hedenqvist P, Östlund A, Hultman J, Wikman A, Riddez L,
Frenckner B, Bottai M, Wahlgren CM. Extracorporeal membrane oxygenation improves
coagulopathy in an experimental traumatic hemorrhagic model. Eur J Trauma Emerg
Surg. 2017 Oct;43(5):701-709. doi: 10.1007/s00068-016-0730-1. Epub 2016 Nov 4.
PubMed PMID: 27815579; PubMed Central PMCID: PMC5629226.

6: Dalle Ave AL, Shaw DM, Gardiner D. Extracorporeal membrane oxygenation (ECMO)
assisted cardiopulmonary resuscitation or uncontrolled donation after the
circulatory determination of death following out-of-hospital refractory cardiac
arrest-An ethical analysis of an unresolved clinical dilemma. Resuscitation. 2016
Nov;108:87-94. doi: 10.1016/j.resuscitation.2016.07.003. Epub 2016 Jul 20.
Review. PubMed PMID: 27449821.

7: Fan X, Chen Z, Nasralla D, Zeng X, Yang J, Ye S, Zhang Y, Peng G, Wang Y, Ye
Q. The organ preservation and enhancement of donation success ratio effect of
extracorporeal membrane oxygenation in circulatory unstable brain death donor.
Clin Transplant. 2016 Oct;30(10):1306-1313. doi: 10.1111/ctr.12823. Epub 2016 Sep
5. PubMed PMID: 27460305.

8: Jasseron C, Lebreton G, Cantrelle C, Legeai C, Leprince P, Flecher E,
Sirinelli A, Bastien O, Dorent R. Impact of Heart Transplantation on Survival in
Patients on Venoarterial Extracorporeal Membrane Oxygenation at Listing in
France. Transplantation. 2016 Sep;100(9):1979-87. doi:
10.1097/TP.0000000000001265. PubMed PMID: 27306536.

9: Migliaccio ML, Zagli G, Cianchi G, Lazzeri C, Bonizzoli M, Cecchi A, Anichini
V, Gensini GF, Peris A. Extracorporeal membrane oxygenation in brain-death organ
and tissues donors: a single-centre experience. Br J Anaesth. 2013
Oct;111(4):673-4. doi: 10.1093/bja/aet323. PubMed PMID: 24027145.

The post EDECMO 42: Organ Transplantation On ECMO appeared first on ED ECMO.

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In this episode, we tackle the subject of organ transplantation on ECMO.  2017 featured several articles showing the efficacy of ECMO for organ transplantation.  In Italy, 56% of total potential patients were successfully transplanted. In this episode, we tackle the subject of organ transplantation on ECMO.  2017 featured several articles showing the efficacy of ECMO for organ transplantation.  In Italy, 56% of total potential patients were successfully transplanted.  The success of these transplants have been comparable to patients not on ECMO.  Zack Shinar interviews Lionel Lamhaut, ECMO specialist from […] the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 32:07 3746
EDECMO 41 – The 3 Stages of ECPR – Diane’s Story https://edecmo.org/edecmo-41-3-stages-ecpr-dianes-story-2/ Sat, 30 Dec 2017 02:04:15 +0000 https://edecmo.org/?p=3711 https://edecmo.org/edecmo-41-3-stages-ecpr-dianes-story-2/#respond https://edecmo.org/edecmo-41-3-stages-ecpr-dianes-story-2/feed/ 0 <p>In this episode Zack and Joe discuss the 3-stages of Extracorporeal Membrane Oxygenation (ECMO) - or put another way, this is how to start Extracorporeal Cardiopulmonary Resuscitation (ECPR) in the Emergency Department (ED). It's been 4 years since we talked about these basic premises of ECPR. But this time, its highlighted in a very special story.</p> <p>The post <a rel="nofollow" href="https://edecmo.org/edecmo-41-3-stages-ecpr-dianes-story-2/">EDECMO 41 – The 3 Stages of ECPR – Diane’s Story</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p> [The original EDECMO 41 post had to be taken down…for reasons beyond our control! But here is the new and improved Episode 41]

In this episode Zack and Joe discuss the 3-stages of Extracorporeal Membrane Oxygenation (ECMO) – or put another way, this is how to start Extracorporeal Cardiopulmonary Resuscitation (ECPR) in the Emergency Department (ED). It's been 4 years since we talked about these basic premises of ECPR. But this time, its highlighted in a very special story.

The Three Stages of ECPR:

  1. Placement of any commercially available catheters into the femoral artery and femoral vein.
    • Ultrasound-guided percutaneous access is our preference, but cutdown is also considered.  This is done in every patient, every time, and is done in parallel to ongoing ACLS. Transduce the arterial line to guide resuscitation and use the venous line for resuscitation purposes.
  2. Transition to ECMO cannulas
    • Using guidewires (we prefer the Amplatz Super Stiff 145 cm .038″ teflon coated floppy tip wires), remove the catheters placed in Stage 1, perform serial dilation, and place ECMO cannulas
  3. Initiate the ECMO pump
    • Perform ‘underwater seal' using crystalloid, which closes the circuit.  The circuit is de-aired and the pump is started.  Increase the RPM to 1500 and remove the clamps.  Inspect the circuit and troubleshoot any issues.

3 stages. 3 steps.

You can find a whole lot more on our ECPR 3 stages page.

EVEN BETTER! If you are interested in learning all about ED ECMO, with hands-on simulators, Wold-renowned ECMO educators, REBOA, ECPR, computer simulation, check out the REANIMATE conference site or go directly to the REANIMATE registration page!!

 

Diane's Story:

November 30, 2017: Diane suffered ventricular fibrillation (VF) cardiac arrest and collapsed…just outside the ED doors.  CPR was started immediately by an ED nurse. After 32 minutes of failed Advanced Cardiac Life Support (ACLS), with human and mechanical chest compressions, she remained in refractory VF.

Our Emergency Physician-initiated ECMO (ED-ECMO) protocol was initiated using the ‘3 stages of ECMO.'   Diane was ‘on pump' in 32 minutes, taken to the cath lab, and had her 95% LAD lesion stented by Interventional Cardiologist Arvin Narula.

Diane went home with her family and friends on December 13, 2017.  Listen to the episode to hear the details…

Diane's Widowmaker

 

 

Dr. Narula, Interventional Cardiology

Joe and Diane

Diane with Casey Gwynn and sister Joanne

Dr. Eads and Diane

Zack Shinar, Diane, and Jessica

Bellezzo And Diane

The post EDECMO 41 – The 3 Stages of ECPR – Diane’s Story appeared first on ED ECMO.

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In this episode Zack and Joe discuss the 3-stages of Extracorporeal Membrane Oxygenation (ECMO) - or put another way, this is how to start Extracorporeal Cardiopulmonary Resuscitation (ECPR) in the Emergency Department (ED). In this episode Zack and Joe discuss the 3-stages of Extracorporeal Membrane Oxygenation (ECMO) - or put another way, this is how to start Extracorporeal Cardiopulmonary Resuscitation (ECPR) in the Emergency Department (ED). It's been 4 years since we talked about these basic premises of ECPR. But this time, its highlighted in a very special story. the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 30:32 3711
EDECMO 40: EROCA – The trial that asks “Should ER Docs Initiate ECPR?” https://edecmo.org/eroca-trial-asks-er-docs-initiate-ecpr/ Thu, 02 Nov 2017 20:00:55 +0000 https://edecmo.org/?p=3602 https://edecmo.org/eroca-trial-asks-er-docs-initiate-ecpr/#respond https://edecmo.org/eroca-trial-asks-er-docs-initiate-ecpr/feed/ 0 <p>  EROCA – University of Michigan – Gunnerson/Shinar Should Emergency Physicians initiate ECMO on arresting patients?  That is the question that Kyle Gunnerson from the University of Michigan (UMich) is asking with their new trial – EROCA.  UMich has had a robust ECMO program for over 30 years and recently they have received a grant […]</p> <p>The post <a rel="nofollow" href="https://edecmo.org/eroca-trial-asks-er-docs-initiate-ecpr/">EDECMO 40: EROCA – The trial that asks “Should ER Docs Initiate ECPR?”</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p>

 

EROCA – University of Michigan – Gunnerson/Shinar

Should Emergency Physicians initiate ECMO on arresting patients?  That is the question that Kyle Gunnerson from the University of Michigan (UMich) is asking with their new trial – EROCA.  UMich has had a robust ECMO program for over 30 years and recently they have received a grant to fund an out of hospital cardiac arrest protocol for emergency physician initiated ECPR.  In this episode, Zack asks Kyle how this trial is being undertaken with key side points on how to start a program, how to train the personnel, and how to circumnavigate the many roadblocks we commonly face in the development of an ECMO program.  They talk about the limitations of running a trial with physicians with no prior experience in ECPR initiation as well as the novel resuscitation strategies that UMich is deploying in all of their cardiac arrest patients.

 

The post EDECMO 40: EROCA – The trial that asks “Should ER Docs Initiate ECPR?” appeared first on ED ECMO.

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  EROCA – University of Michigan – Gunnerson/Shinar Should Emergency Physicians initiate ECMO on arresting patients?  That is the question that Kyle Gunnerson from the University of Michigan (UMich) is asking with their new trial – EROCA.   EROCA – University of Michigan – Gunnerson/Shinar Should Emergency Physicians initiate ECMO on arresting patients?  That is the question that Kyle Gunnerson from the University of Michigan (UMich) is asking with their new trial – EROCA.  UMich has had a robust ECMO program for over 30 years and recently they have received a grant […] the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 28:36 3602
EDECMO 39: Who Do We Put On ECMO? – New Data on Prognostics https://edecmo.org/edecmo-39-put-ecmo-new-data-prognostics/ Fri, 06 Oct 2017 04:43:54 +0000 https://edecmo.org/?p=3534 https://edecmo.org/edecmo-39-put-ecmo-new-data-prognostics/#comments https://edecmo.org/edecmo-39-put-ecmo-new-data-prognostics/feed/ 2 <p>In this episode Zack interviews the first authors of the three biggest papers this year dealing with the question of “Who should I put on ECMO?”  Guillaume Debaty of Grenoble, France published a paper outlining what prognostic factors are important.  Guillaume's data shows importance of short low times, lower lactates and higher pH values.  The real question is what number for each of these should we consider a hard stop on initiation.  This is followed up by Josh Reynolds who along with Ben Singer out of the UK published a paper utilizing cardiac arrest data from the PRIMED trial.  He showed that even patients with all the advantageous characteristics of traditional ECMO inclusion criteria had poor survivals once they have had >30 minutes of chest compressions.  With many ECMO studies having average arrest to</p> <p>initiation times of > 60 minutes, Josh’s paper certainly makes us view favorably the 30% survival outcomes that we are seeing worldwide.  This in no way substitutes for a randomized trial but does offer some guidance on what the expected survival of a patient with a witnessed arrest, short low flow times, and age < 65.   We  conclude with Nate Haas out of the University of Michigan who utilitzed the ELSO database to show that age was not predictive of survival.  This may push us towards including older patients in our inclusion criteria, but more data is definitely needed on this. </p> <p>The post <a rel="nofollow" href="https://edecmo.org/edecmo-39-put-ecmo-new-data-prognostics/">EDECMO 39: Who Do We Put On ECMO? – New Data on Prognostics</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p>

In this episode Zack interviews the first authors of the three biggest papers this year dealing with the question of “Who should I put on ECMO?”  Guillaume Debaty of Grenoble, France published a paper outlining what prognostic factors are important.  Guillaume's data shows importance of short low times, lower lactates and higher pH values.  The real question is what number for each of these should we consider a hard stop on initiation.  This is followed up by Josh Reynolds who along with Ben Singer out of the UK published a paper utilizing cardiac arrest data from the PRIMED trial.  He showed that even patients with all the advantageous characteristics of traditional ECMO inclusion criteria had poor survivals once they have had >30 minutes of chest compressions.  With many ECMO studies having average arrest to

initiation times of > 60 minutes, Josh’s paper certainly makes us view favorably the 30% survival outcomes that we are seeing worldwide.  This in no way substitutes for a randomized trial but does offer some guidance on what the expected survival of a patient with a witnessed arrest, short low flow times, and age < 65.   We  conclude with Nate Haas out of the University of Michigan who utilitzed the ELSO database to show that age was not predictive of survival.  This may push us towards including older patients in our inclusion criteria, but more data is definitely needed on this.

 

Bibliography:

1: Haas NL, Coute RA, Hsu CH, Cranford JA, Neumar RW. Descriptive analysis of
extracorporeal cardiopulmonary resuscitation following out-of-hospital cardiac
arrest-An ELSO registry study
. Resuscitation. 2017 Oct;119:56-62. doi:
10.1016/j.resuscitation.2017.08.003. Epub 2017 Aug 5. PubMed PMID: 1.

 

2: Reynolds JC, Grunau BE, Elmer J, Rittenberger JC, Sawyer KN, Kurz MC, Singer
B, Proudfoot A, Callaway CW. Prevalence, natural history, and time-dependent
outcomes of a multi-center North American cohort of out-of-hospital cardiac
arrest extracorporeal CPR candidates. Resuscitation. 2017 Aug;117:24-31. doi:
10.1016/j.resuscitation.2017.05.024. Epub 2017 May 25. PubMed PMID: 2.

 

3: Debaty G, Babaz V, Durand M, Gaide-Chevronnay L, Fournel E, Blancher M,
Bouvaist H, Chavanon O, Maignan M, Bouzat P, Albaladejo P, Labarère J. Prognostic
factors for extracorporeal cardiopulmonary resuscitation recipients following
out-of-hospital refractory cardiac arrest. A systematic review and meta-analysis.
Resuscitation. 2017 Mar;112:1-10. doi: 10.1016/j.resuscitation.2016.12.011. Epub
2016 Dec 19. Review. PubMed PMID: 3.

References

1.
Haas N, Coute R, Hsu C, Cranford J, Neumar R. Descriptive analysis of extracorporeal cardiopulmonary resuscitation following out-of-hospital cardiac arrest-An ELSO registry study
. Resuscitation. 2017;119:56-62. [PubMed]
2.
Reynolds J, Grunau B, Elmer J, et al. Prevalence, natural history, and time-dependent outcomes of a multi-center North American cohort of out-of-hospital cardiac arrest extracorporeal CPR candidates. Resuscitation. 2017;117:24-31. [PubMed]
3.
Debaty G, Babaz V, Durand M, et al. Prognostic factors for extracorporeal cardiopulmonary resuscitation recipients following out-of-hospital refractory cardiac arrest. A systematic review and meta-analysis. Resuscitation. 2017;112:1-10. [PubMed]

The post EDECMO 39: Who Do We Put On ECMO? – New Data on Prognostics appeared first on ED ECMO.

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In this episode Zack interviews the first authors of the three biggest papers this year dealing with the question of “Who should I put on ECMO?”  Guillaume Debaty of Grenoble, France published a paper outlining what prognostic factors are important. In this episode Zack interviews the first authors of the three biggest papers this year dealing with the question of “Who should I put on ECMO?”  Guillaume Debaty of Grenoble, France published a paper outlining what prognostic factors are important.  Guillaume's data shows importance of short low times, lower lactates and higher pH values.  The real question is what number for each of these should we consider a hard stop on initiation.  This is followed up by Josh Reynolds who along with Ben Singer out of the UK published a paper utilizing cardiac arrest data from the PRIMED trial.  He showed that even patients with all the advantageous characteristics of traditional ECMO inclusion criteria had poor survivals once they have had >30 minutes of chest compressions.  With many ECMO studies having average arrest to<br /> <br /> initiation times of > 60 minutes, Josh’s paper certainly makes us view favorably the 30% survival outcomes that we are seeing worldwide.  This in no way substitutes for a randomized trial but does offer some guidance on what the expected survival of a patient with a witnessed arrest, short low flow times, and age < 65.   We  conclude with Nate Haas out of the University of Michigan who utilitzed the ELSO database to show that age was not predictive of survival.  This may push us towards including older patients in our inclusion criteria, but more data is definitely needed on this. the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 36:15 3534
Crash Episode: Iowa OHCA ECMO Save – with Andrew Karl Terry https://edecmo.org/crash-episode-iowa-ohca-ecmo-save-andrew-karl-terry/ Thu, 07 Sep 2017 05:20:54 +0000 https://edecmo.org/?p=3421 https://edecmo.org/crash-episode-iowa-ohca-ecmo-save-andrew-karl-terry/#comments https://edecmo.org/crash-episode-iowa-ohca-ecmo-save-andrew-karl-terry/feed/ 5 <p>Mini episode - This is a great example of where a little persistence with your colleagues can help save someone's life.  Dr. Andrew Karl Terry, having had only limited exposure to ECMO, was able to encourage his Cardiologists to put a witnessed VF patient on ECMO.  The rest is history!</p> <p>The post <a rel="nofollow" href="https://edecmo.org/crash-episode-iowa-ohca-ecmo-save-andrew-karl-terry/">Crash Episode: Iowa OHCA ECMO Save – with Andrew Karl Terry</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p>

Crash Episode – This is a great example of where a little persistence with your colleagues can help save someone's life.  Dr. Andrew Karl Terry, having had only limited exposure to ECMO, was able to encourage his Cardiologists to put a witnessed VF patient on ECMO.  The rest is history!

The post Crash Episode: Iowa OHCA ECMO Save – with Andrew Karl Terry appeared first on ED ECMO.

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Mini episode - This is a great example of where a little persistence with your colleagues can help save someone's life.  Dr. Andrew Karl Terry, having had only limited exposure to ECMO, was able to encourage his Cardiologists to put a witnessed VF pati... Mini episode - This is a great example of where a little persistence with your colleagues can help save someone's life.  Dr. Andrew Karl Terry, having had only limited exposure to ECMO, was able to encourage his Cardiologists to put a witnessed VF patient on ECMO.  The rest is history! the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 11:12 3421
EDECMO 38 – ECMO and Trauma – with Pal Ager-Wick and Magnus Larsson https://edecmo.org/edecmo-38-ecmo-trauma-pal-ager-wick-magnus-larsson/ Mon, 28 Aug 2017 00:13:54 +0000 https://edecmo.org/?p=3355 https://edecmo.org/edecmo-38-ecmo-trauma-pal-ager-wick-magnus-larsson/#comments https://edecmo.org/edecmo-38-ecmo-trauma-pal-ager-wick-magnus-larsson/feed/ 2 <p>This episode is all about ECMO in trauma - not the usual ARDS, TRALI VV-ECMO - we’re talking about VA ECMO for the acutely dying trauma patient. Zack interviews Pål Ager-Wick from Tromso Norway, and Magnus Larsson from the Karolinska Institute in Stockholm. We talk about everything from how ECMO helps the hemorrhaging trauma patient to the futuristic “Emergency Preservation and Resuscitation” concept being done in Baltimore now.</p> <p>The post <a rel="nofollow" href="https://edecmo.org/edecmo-38-ecmo-trauma-pal-ager-wick-magnus-larsson/">EDECMO 38 – ECMO and Trauma – with Pal Ager-Wick and Magnus Larsson</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p> ECMO in trauma

This episode is all about ECMO in trauma – not the usual ARDS, TRALI VV-ECMO – we’re talking about VA ECMO for the acutely dying trauma patient. Zack interviews Pål Ager-Wick from Tromso Norway, and Magnus Larsson from the Karolinska Institute in Stockholm. We talk about everything from how ECMO helps the hemorrhaging trauma patient to the futuristic “Emergency Preservation and Resuscitation” concept being done in Baltimore now.

Photo used with permission of SAMU of Paris


Bullet Points:

  • VV ECMO –
    • Marginal data suggests ECMO beneficial in ARDS (CESAR, ANZECMO trials)
    • ARDS and TRALI in trauma is a reasonable extension of this
  • Damage Control Surgery –
    • focus on coagulation
    • stop major bleeders and then take to ICU
    • lethal triad of coagulation includes hypothermia, dilution of coagulation factors and acidosis
  • Coagulation of trauma: ECMO can improve all three components of lethal triad
  • Heparin has been successfully withheld in bleeding trauma patients
  • ECMO in Severe Chest Trauma – 10 patients, 8 ruptured cardiac chambers1
  • Blunt cardiac arrest – a case report2
  • Bleeding less than 15% mortality after 1995, Intracranial hemorrhage patients can survive. In fact none of the ICH patients on ECMO who died died of brain bleeding (60-93% survived). Survival was 42-63% for VA ECMO. Lower ACT (<180 sec)3
  • ELSO – VA ECMO in trauma – 45% survival4
  • ECMO reduces venous pressure which may be beneficial in hemorrhaging patients5
  • Tisherman – Suspended Animation: Emergency Preservation and Resuscitation678

Magnus Larsson

References

1.
Huh U, Song S, Chung S, et al. Is Extracorporeal Cardiopulmonary Resuscitation Practical in Severe Chest Trauma? : A Systematic Review in Single Center of Developing Country. J Trauma Acute Care Surg. August 2017. [PubMed]
2.
Kudo S, Tanaka K, Okada K, Takemura T. Extracorporeal cardiopulmonary resuscitation for blunt cardiac rupture: A case report. Am J Emerg Med. August 2017. [PubMed]
3.
Bedeir K, Seethala R, Kelly E. Extracorporeal life support in trauma: Worth the risks? A systematic review of published series. J Trauma Acute Care Surg. 2017;82(2):400-406. [PubMed]
4.
ELSO Registry. Extracoporeal Life Support Organization. http://www.elso.org/Registry/Statistics/InternationalSummary.aspx.
5.
Larsson M, Talving P, Palmér K, Frenckner B, Riddez L, Broomé M. Experimental extracorporeal membrane oxygenation reduces central venous pressure: an adjunct to control of venous hemorrhage? Perfusion. 2010;25(4):217-223. [PubMed]
6.
Tisherman S, Safar P, Radovsky A, Peitzman A, Sterz F, Kuboyama K. Therapeutic deep hypothermic circulatory arrest in dogs: a resuscitation modality for hemorrhagic shock with “irreparable” injury. J Trauma. 1990;30(7):836-847. [PubMed]
7.
Tisherman S. Salvage techniques in traumatic cardiac arrest: thoracotomy, extracorporeal life support, and therapeutic hypothermia. Curr Opin Crit Care. 2013;19(6):594-598. [PubMed]
8.
Kutcher M, Forsythe R, Tisherman S. Emergency preservation and resuscitation for cardiac arrest from trauma. Int J Surg. 2016;33(Pt B):209-212. [PubMed]

The post EDECMO 38 – ECMO and Trauma – with Pal Ager-Wick and Magnus Larsson appeared first on ED ECMO.

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This episode is all about ECMO in trauma - not the usual ARDS, TRALI VV-ECMO - we’re talking about VA ECMO for the acutely dying trauma patient. Zack interviews Pål Ager-Wick from Tromso Norway, and Magnus Larsson from the Karolinska Institute in Stock... This episode is all about ECMO in trauma - not the usual ARDS, TRALI VV-ECMO - we’re talking about VA ECMO for the acutely dying trauma patient. Zack interviews Pål Ager-Wick from Tromso Norway, and Magnus Larsson from the Karolinska Institute in Stockholm. We talk about everything from how ECMO helps the hemorrhaging trauma patient to the futuristic “Emergency Preservation and Resuscitation” concept being done in Baltimore now. the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 31:34 3355
EDECMO 37 – Nate’s Story https://edecmo.org/edecmo-37-what-if-you-had-to-put-your-own-dying-child-on-ecmo/ Fri, 21 Jul 2017 18:20:53 +0000 https://edecmo.org/?p=3260 https://edecmo.org/edecmo-37-what-if-you-had-to-put-your-own-dying-child-on-ecmo/#comments https://edecmo.org/edecmo-37-what-if-you-had-to-put-your-own-dying-child-on-ecmo/feed/ 1 <p>Jake is an Emergency Physician from Santa Cruz California whose interest in resuscitation was put to the fullest test when his own son had a cardiac arrest. This is the amazing retelling of that day in November when what Jake learned in an EDECMO workshop was utilized in a dramatic fashion. This is a story of two heros: Jake and his son Nate.</p> <p>The post <a rel="nofollow" href="https://edecmo.org/edecmo-37-what-if-you-had-to-put-your-own-dying-child-on-ecmo/">EDECMO 37 – Nate’s Story</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p> Jake is an Emergency Physician from Santa Cruz California whose interest in resuscitation was put to the fullest test when his own son had a cardiac arrest. This is the amazing retelling of that day in November when what Jake learned in an EDECMO workshop was utilized in a dramatic fashion. This is a story of two heros: Jake and his son Nate.

The post EDECMO 37 – Nate’s Story appeared first on ED ECMO.

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Jake is an Emergency Physician from Santa Cruz California whose interest in resuscitation was put to the fullest test when his own son had a cardiac arrest. This is the amazing retelling of that day in November when what Jake learned in an EDECMO works... Jake is an Emergency Physician from Santa Cruz California whose interest in resuscitation was put to the fullest test when his own son had a cardiac arrest. This is the amazing retelling of that day in November when what Jake learned in an EDECMO workshop was utilized in a dramatic fashion. This is a story of two heros: Jake and his son Nate. the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 32:38 3260
Crash Episode – MicroDissection of Yannopoulos’ ECMO Method https://edecmo.org/crash-episode-microdissection-yannopoulos-ecmo-method/ Sat, 15 Jul 2017 20:50:46 +0000 https://edecmo.org/?p=3256 https://edecmo.org/crash-episode-microdissection-yannopoulos-ecmo-method/#comments https://edecmo.org/crash-episode-microdissection-yannopoulos-ecmo-method/feed/ 1 <p>The University of Minnesota Cath Lab Cannulation Method</p> <p>The post <a rel="nofollow" href="https://edecmo.org/crash-episode-microdissection-yannopoulos-ecmo-method/">Crash Episode – MicroDissection of Yannopoulos’ ECMO Method</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p> In ep. 36, Zack interviewed Demetris Yannopoulos on the amazing ECPR experience at University of Minnesota. In this crash episode, I reinterview Dr. Yannopoulos on the intricacies of how cannulates.

Some Highlights

  • Uses amplatz super-stiff with 1cm J-tip
  • arterial puncture first
  • dilates with 12 and 14 for artery and 16 and 18 for vein
  • places venous cannula first
  • 25 F venous cannula
  • places arterial 15 F in females and 17 F in males empirically (different than publication)
  • Dilates tracts with kelly
  • Starts flow at 2.5 50% fio2 and ramps up
  • His leg perfusion cath of choice is the 9F Arrow Mac. He uses the big sideport for blood flow and the smaller one to run the systemic heparin

 

 

 

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The University of Minnesota Cath Lab Cannulation Method The University of Minnesota Cath Lab Cannulation Method the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 35:41 3256
EDECMO 36 – Crushing the Nihilism of Cardiac Arrest – with Demetris Yannopoulos https://edecmo.org/edecmo-36-crushing-nihilism-cardiac-arrest-demetri-yannopoulos/ Fri, 09 Jun 2017 22:40:23 +0000 https://edecmo.org/?p=3210 https://edecmo.org/edecmo-36-crushing-nihilism-cardiac-arrest-demetri-yannopoulos/#respond https://edecmo.org/edecmo-36-crushing-nihilism-cardiac-arrest-demetri-yannopoulos/feed/ 0 <p>In this podcast episode, Zack interviews Demetri Yannopoulos from the University of Minnesota. Demetri has organized Minneapolis into arguably the most impressive ECPR city in the world. He has changed the mindset of out of hospital refractory ventricular fibrillation care from “stay and play”, the philosophy that medics should stay at the scene and provide care until ROSC (return of spontaneous circulation) or until the patient is pronounced dead. In Minneapolis, a patient who who arrests in  Yannopoulos’ catchment area gets three shocks. If the patient does not get ROSC then they are immediately transported to the University of Minnesota using LUCAS mechanical chest compression device. The patient bypasses the emergency department and goes directly to the cath lab. In the cath lab, Demetri, or one of his partners, cannulates and initiates ECMO with an average time of 6 minutes!!! In his first 90 patients he has had a 45% neurologically intact survivorship. Patients are getting to the cath lab on average 60 minutes after their arrest. In this cohort, you would expect a less than 1% survival. We can use Dr. Yannopoulos’ model to expand the use of ECPR in many other systems. The real question is do we have champions like Demetri who will rise to the calling!</p> <p>The post <a rel="nofollow" href="https://edecmo.org/edecmo-36-crushing-nihilism-cardiac-arrest-demetri-yannopoulos/">EDECMO 36 – Crushing the Nihilism of Cardiac Arrest – with Demetris Yannopoulos</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p>

…all acute injury to the heart is reversible.

 

Demetris Yannapoulos
University of Minnesota

In this podcast episode, Zack interviews Demetris Yannopoulos from the University of Minnesota. Demetris has organized Minneapolis into arguably the most impressive ECPR city in the world. He has changed the mindset of out of hospital refractory ventricular fibrillation care from “stay and play”, the philosophy that medics should stay at the scene and provide care until ROSC (return of spontaneous circulation) or until the patient is pronounced dead. In Minneapolis, a patient who who arrests in  Yannopoulos’ catchment area gets three shocks. If the patient does not get ROSC then they are immediately transported to the University of Minnesota using LUCAS mechanical chest compression device. The patient bypasses the emergency department and goes directly to the cath lab. In the cath lab, Demetris, or one of his partners, cannulates and initiates ECMO with an average time of 6 minutes!!! In his first 90 patients he has had a 45% neurologically intact survivorship. Patients are getting to the cath lab on average 60 minutes after their arrest. In this cohort, you would expect a less than 1% survival. We can use Dr. Yannopoulos’ model to expand the use of ECPR in many other systems. The real question is do we have champions like Demetris who will rise to the calling!

The post EDECMO 36 – Crushing the Nihilism of Cardiac Arrest – with Demetris Yannopoulos appeared first on ED ECMO.

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In this podcast episode, Zack interviews Demetri Yannopoulos from the University of Minnesota. Demetri has organized Minneapolis into arguably the most impressive ECPR city in the world. He has changed the mindset of out of hospital refractory ventricu... In this podcast episode, Zack interviews Demetri Yannopoulos from the University of Minnesota. Demetri has organized Minneapolis into arguably the most impressive ECPR city in the world. He has changed the mindset of out of hospital refractory ventricular fibrillation care from “stay and play”, the philosophy that medics should stay at the scene and provide care until ROSC (return of spontaneous circulation) or until the patient is pronounced dead. In Minneapolis, a patient who who arrests in  Yannopoulos’ catchment area gets three shocks. If the patient does not get ROSC then they are immediately transported to the University of Minnesota using LUCAS mechanical chest compression device. The patient bypasses the emergency department and goes directly to the cath lab. In the cath lab, Demetri, or one of his partners, cannulates and initiates ECMO with an average time of 6 minutes!!! In his first 90 patients he has had a 45% neurologically intact survivorship. Patients are getting to the cath lab on average 60 minutes after their arrest. In this cohort, you would expect a less than 1% survival. We can use Dr. Yannopoulos’ model to expand the use of ECPR in many other systems. The real question is do we have champions like Demetri who will rise to the calling! the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 29:03 3210
EDECMO 35 – REBOA REVISITED! https://edecmo.org/edecmo-35-reboa-revisited/ Fri, 07 Apr 2017 19:29:09 +0000 https://edecmo.org/?p=3129 https://edecmo.org/edecmo-35-reboa-revisited/#comments https://edecmo.org/edecmo-35-reboa-revisited/feed/ 1 <p>REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) is used to gain proximal control over non-compressible hemorrhage below the diaphragm. In this episode, Zack takes a deep dive into REBOA implementation, physiology, and complications with four of the biggest movers in the world of REBOA:</p> <p>The post <a rel="nofollow" href="https://edecmo.org/edecmo-35-reboa-revisited/">EDECMO 35 – REBOA REVISITED!</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p> REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) is used to gain proximal control over non-compressible hemorrhage below the diaphragm.  The concept has been covered extensively in social media.

Weingart did a wonderful job describing REBOA using the 12F Chek-Flo and CODA catheter here:

EMCrit Podcast 121 – REBOA

Our good friend Rob Orman from ERCAST.org and EMRAP interviewed Zaf Qasim:

REBOA 101

And Weingart revisited REBOA, spoke with Joe DuBose, and described the newest REBOA catheter, the PryTime 7F ER REBOA catheter that most of us now use:

Podcast 170 – the ER REBOA Catheter with Joe DuBose

 

…So we aren't going to rehash any of that stuff in this episode!

In this episode, Zack takes a deep dive into REBOA implementation, physiology, and complications with four of the biggest movers in the world of REBOA:

Dr. David Callaway Military Trauma Specialist

Dr. David Callaway is an Emergency Physician from the Carolinas Health System, who also serves on the Defense Health Board Subcommittee on Trauma and Injury as well as the Committee on Tactical Combat Casualty Care- two of the key U.S. advisory bodies for battlefield trauma care. He is the Co- Chairman of the Committee for Tactical Emergency Casualty Care, a best practices R&D group charged with translating battlefield lessons learned to civilian high threat prehospital medicine.

Dr. Callaway describes how they implement REBOA  in their busy trauma unit and some of the data behind its use.


 

Dr. Tatuya Norii University of New Mexico

But REBOA is not without controversy.  So Zack turned to Dr. Tatsuyo Norii, from the University of New Mexico, who published a study that showed that REBOA may result in increased mortality in certain patients.1 Dr. Norii believes that we should avoid REBOA in patients with traumatic brain injury and patients with multi-system trauma.

Shinar and Dr. Norii also discussed how REBOA may also be considered  non-trauma situations where patients are bleeding to death:  ruptured ectopic pregnancy, postpartum hemorrhage, ruptured abdominal aneurysm, and perhaps some patients with hemorrhagic gastrointestinal bleeding.

 


Austin Johnson MD PhD UC Davis

Then,  Zack turned to Dr. Austin Johnson from UC Davis.  They do  a deep dive into the physiology of of a patient on REBOA and its nuances in traumatic brain injury.

And lastly, They discussed the concept of partial REBOA (P-REBOA) and the concept of “windsocking”. As the balloon size is decreased by decreasing the volumes within it, the flow around the balloon is not linear. This becomes increasingly important as we consider ‘partial REBOA', prolonged occlusion, and balloon takedown, a topic published by Dr. Johnson a few months ago.2

 


Zaf Qasim MD REBOA guru

Finally, we wrap things up with a discussion with Zaf Qasim, REBOA guru who teaches the REBOA modules at our endovascular resuscitation conference, REANIMATE.

Do you want to learn how to aggressively manage the crashing trauma and medical patients using ECMO, ECPR, REBOA, ultrasound  and advanced resuscitation techniques?

 

REANIMATE 4 is September 21-22, 2017:

Register for REANIMATE 4

References

1.
Norii T, Crandall C, Terasaka Y. Survival of severe blunt trauma patients treated with resuscitative endovascular balloon occlusion of the aorta compared with propensity score-adjusted untreated patients. J Trauma Acute Care Surg. 2015;78(4):721-728. [PubMed]
2.
Johnson M, Neff L, Williams T, DuBose J, EVAC S. Partial resuscitative balloon occlusion of the aorta (P-REBOA): Clinical technique and rationale. J Trauma Acute Care Surg. 2016;81(5 Suppl 2 Proceedings of the 2015 Military Health System Research Symposium):S133-S137. [PubMed]

The post EDECMO 35 – REBOA REVISITED! appeared first on ED ECMO.

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REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) is used to gain proximal control over non-compressible hemorrhage below the diaphragm. In this episode, Zack takes a deep dive into REBOA implementation, physiology, REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) is used to gain proximal control over non-compressible hemorrhage below the diaphragm. In this episode, Zack takes a deep dive into REBOA implementation, physiology, and complications with four of the biggest movers in the world of REBOA: the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 34:42 3129
EDECMO 34 – The Day After REANIMATE – with Dr. Sean Deitch https://edecmo.org/edecmo-34-day-reanimate-dr-sean-deitch/ Wed, 15 Mar 2017 20:07:21 +0000 https://edecmo.org/?p=3090 https://edecmo.org/edecmo-34-day-reanimate-dr-sean-deitch/#comments https://edecmo.org/edecmo-34-day-reanimate-dr-sean-deitch/feed/ 1 <p>In this episode, Joe talks with Dr. Sean Deitch, a non-academic Emergency Physician practicing in San Diego, California. Dr. Deitch attended REANIMATE 3 - which just finished 2 weeks ago...and has an amazing story to tell. You'll have to listen to the episode...</p> <p>REANIMATE 4 is September 21-22, 2017 and features guest faculty member Stephen Bernard - coming all the way from Melbourne, Australia - and best know from the original therapeutic hypothermia trials and CHEER. R3 was amazing and R4 will be even better!!</p> <p>The post <a rel="nofollow" href="https://edecmo.org/edecmo-34-day-reanimate-dr-sean-deitch/">EDECMO 34 – The Day After REANIMATE – with Dr. Sean Deitch</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p> In this episode, Joe talks with Dr. Sean Deitch, a non-academic Emergency Physician practicing in San Diego, California.  Dr. Deitch attended REANIMATE 3 – which just finished 2 weeks ago…and has an amazing story to tell.  You'll have to listen to the episode…

REANIMATE 4 is September 21-22, 2017 and features guest faculty member Stephen Bernard – coming all the way from Melbourne, Australia – and best know from the original therapeutic hypothermia trials and CHEER.  R3 was amazing and R4 will be even better!!

To register for REANIMATE 4: www.reanimateconference.com/register

 

The post EDECMO 34 – The Day After REANIMATE – with Dr. Sean Deitch appeared first on ED ECMO.

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In this episode, Joe talks with Dr. Sean Deitch, a non-academic Emergency Physician practicing in San Diego, California. Dr. Deitch attended REANIMATE 3 - which just finished 2 weeks ago...and has an amazing story to tell. In this episode, Joe talks with Dr. Sean Deitch, a non-academic Emergency Physician practicing in San Diego, California. Dr. Deitch attended REANIMATE 3 - which just finished 2 weeks ago...and has an amazing story to tell. You'll have to listen to the episode...<br /> <br /> REANIMATE 4 is September 21-22, 2017 and features guest faculty member Stephen Bernard - coming all the way from Melbourne, Australia - and best know from the original therapeutic hypothermia trials and CHEER. R3 was amazing and R4 will be even better!! the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 16:02 3090
EDECMO 33a – “Bringing Down the House” by Zack Shinar (from RESUSfest 2016) https://edecmo.org/edecmo-33a-bringing-house-zack-shinar-resusfest-2016/ Thu, 26 Jan 2017 07:49:55 +0000 https://edecmo.org/?p=2970 https://edecmo.org/edecmo-33a-bringing-house-zack-shinar-resusfest-2016/#comments https://edecmo.org/edecmo-33a-bringing-house-zack-shinar-resusfest-2016/feed/ 2 <p>In this episode of the EDECMO podcast, Zack describes how to use the concept of 'TEAM PLAY", much like the gang from the classic novel "Bringing Down the House" by Ben Mezrich, to optimize outcomes after cardiac arrest....with, or without, ECPR. </p> <p>The post <a rel="nofollow" href="https://edecmo.org/edecmo-33a-bringing-house-zack-shinar-resusfest-2016/">EDECMO 33a – “Bringing Down the House” by Zack Shinar (from RESUSfest 2016)</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p> In this episode of the EDECMO podcast, Zack describes how to use the concept of ‘TEAM PLAY”, much like the gang from the classic novel “Bringing Down the House” by Ben Mezrich, to optimize outcomes after cardiac arrest….with, or without, ECPR.

Zack's tips for running a code:

  1. Proper, high-quality CPR
  2. The choreography of running a code
  3. Let your nurses run the code
  4. CPR Alfresco (transitioning the patient from EMS gurney to hospital gurney IN THE AMBULANCE BAY)

Upcoming EVENTS:

REANIMATE 3 Conference: March 2-3, 2017 (sold out! but click the link to go to the wait list)

REANIMATE 4 Conference: September 21-22, 2017  (registration will open on March 21, 2017. Add your name to the REANIMATE wait list for first chance at R4 tickets)

Castlefest 2017: April 10-14, 2017

Resusfest 2017: April 13-14, 2017

Essentials of Emergency Medicine 2017 at the Cosmopolitan Hotel in Las Vegas, Nevada: May 16-18, 2017

 

Bringing Down the House:

 

The post EDECMO 33a – “Bringing Down the House” by Zack Shinar (from RESUSfest 2016) appeared first on ED ECMO.

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In this episode of the EDECMO podcast, Zack describes how to use the concept of 'TEAM PLAY", much like the gang from the classic novel "Bringing Down the House" by Ben Mezrich, to optimize outcomes after cardiac arrest....with, or without, ECPR. In this episode of the EDECMO podcast, Zack describes how to use the concept of 'TEAM PLAY", much like the gang from the classic novel "Bringing Down the House" by Ben Mezrich, to optimize outcomes after cardiac arrest....with, or without, ECPR. the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 19:12 2970
EDECMO 32 – Archimedes Screw: Is Impella the Future of Mechanical Circulatory Support? https://edecmo.org/edecmo-32-archimedes-screw-impella-future-mechanical-circulatory-support/ Wed, 07 Dec 2016 00:34:12 +0000 https://edecmo.org/?p=2890 https://edecmo.org/edecmo-32-archimedes-screw-impella-future-mechanical-circulatory-support/#respond https://edecmo.org/edecmo-32-archimedes-screw-impella-future-mechanical-circulatory-support/feed/ 0 <p>In this episode we explore two very different applications of the Impella® device - a percutaneously-placed temporary ventricular assist device (VAD) sold by Abiomed (no financial disclosures). These VADs work by the use of a micro-axillary pump which is typically placed by interventional cardiologists under fluoroscopy. The inlet of the pump is placed in the ventrical while the outlet rests just above the aortic valve.</p> <p>The post <a rel="nofollow" href="https://edecmo.org/edecmo-32-archimedes-screw-impella-future-mechanical-circulatory-support/">EDECMO 32 – Archimedes Screw: Is Impella the Future of Mechanical Circulatory Support?</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p> In this episode we change direction a bit and explore two very different applications of the Impella® device – a percutaneously-placed temporary ventricular assist device (VAD) sold by Abiomed (no financial disclosures). These VADs work by the use of a micro-axillary pump which is typically placed by interventional cardiologists under fluoroscopy. The inlet of the pump is placed in the ventrical while the outlet rests just above the aortic valve.  Take a look at this video for a  better understanding of how this works:

Guests on this show:

portrait-holst-jenelle-ann

Jenelle Badulak MD Critical Care Fellow University of Washington

vase

Dr. Henrik Vase Interventional Cardiologist Aarhus University Hospital, Denmark

 

 

EB Compton's/Archimedes screw/harchmd001a4 465 x 331/ cmccabe/09/28/2009

The post EDECMO 32 – Archimedes Screw: Is Impella the Future of Mechanical Circulatory Support? appeared first on ED ECMO.

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In this episode we explore two very different applications of the Impella® device - a percutaneously-placed temporary ventricular assist device (VAD) sold by Abiomed (no financial disclosures). These VADs work by the use of a micro-axillary pump which ... In this episode we explore two very different applications of the Impella® device - a percutaneously-placed temporary ventricular assist device (VAD) sold by Abiomed (no financial disclosures). These VADs work by the use of a micro-axillary pump which is typically placed by interventional cardiologists under fluoroscopy. The inlet of the pump is placed in the ventrical while the outlet rests just above the aortic valve. the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 37:39 2890
EDECMO 31 – Anaphylaxis & Epi-Pens. Are we ready for VV-ECMO in the Emergency Department? https://edecmo.org/edecmo-31-anaphylaxis-epi-pens-ready-vv-ecmo-emergency-department/ Tue, 11 Oct 2016 19:14:17 +0000 https://edecmo.org/?p=2783 https://edecmo.org/edecmo-31-anaphylaxis-epi-pens-ready-vv-ecmo-emergency-department/#comments https://edecmo.org/edecmo-31-anaphylaxis-epi-pens-ready-vv-ecmo-emergency-department/feed/ 6 <p>Here is a case of a young man who presented to the Emergency Department with profound anaphylaxis. This was a "CAN Intubate/CAN'T VENTILATE" scenario: </p> <p>Max Epinephrine<br /> Max antihistamines<br /> Max steroids<br /> Max ventilator<br /> What options do you have? Find out in this episode.</p> <p>The post <a rel="nofollow" href="https://edecmo.org/edecmo-31-anaphylaxis-epi-pens-ready-vv-ecmo-emergency-department/">EDECMO 31 – Anaphylaxis & Epi-Pens. Are we ready for VV-ECMO in the Emergency Department?</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p> 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:

  1. Max Epinephrine
  2. Max antihistamines
  3. Max steroids
  4. 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

Kevin Shaw MD
Intensive Care
Sharp Memorial Hospital

Andrew Eads MD Emergency Medicine Sharp Memorial Hospital

Andrew Eads MD
Emergency Medicine
Sharp Memorial Hospital

Melissa Brunsvold MD Department of Surgery University of Minnesota

Melissa Brunsvold MD
Department of Surgery
University of Minnesota

Conrad Soriano

Conrad Soriano

Brynn Shinar Cutest Girl on Earth

Brynn Shinar
Cutest Girl on Earth

The post EDECMO 31 – Anaphylaxis & Epi-Pens. Are we ready for VV-ECMO in the Emergency Department? appeared first on ED ECMO.

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Here is a case of a young man who presented to the Emergency Department with profound anaphylaxis. This was a "CAN Intubate/CAN'T VENTILATE" scenario: - Max Epinephrine Max antihistamines Max steroids Max ventilator What options do you have? Here is a case of a young man who presented to the Emergency Department with profound anaphylaxis. This was a "CAN Intubate/CAN'T VENTILATE" scenario: <br /> <br /> Max Epinephrine<br /> Max antihistamines<br /> Max steroids<br /> Max ventilator<br /> What options do you have? Find out in this episode. the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 27:44 2783
EDECMO 30 – Post-Arrest ECMO Critical Care Management with Deirdre Murphy https://edecmo.org/post-arrest-ecmo-critical-care-management-deirdre-murphy/ Fri, 09 Sep 2016 18:04:18 +0000 https://edecmo.org/?p=2516 https://edecmo.org/post-arrest-ecmo-critical-care-management-deirdre-murphy/#respond https://edecmo.org/post-arrest-ecmo-critical-care-management-deirdre-murphy/feed/ 0 <p>Post Pump Crit Care</p> <p>The post <a rel="nofollow" href="https://edecmo.org/post-arrest-ecmo-critical-care-management-deirdre-murphy/">EDECMO 30 – Post-Arrest ECMO Critical Care Management with Deirdre Murphy</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p> In this episode, Scott talks with Deirdre Murphy, guru on all things Cardiothoracic Critical Care, on the topic of post-pump crit care.

The Alfred has put itself on the map in so many ways over the past decade. Home to Stephen Bernard (of the original Hypothermia after ROSC without RONF fame), Chris Nickson (@precordialthump, @ragepodcast, @intensiveblog, #SMACC, lifeinthefastlane.com), and good friends Jason McClure, Steve McGloughlin, Josh Ihle, Paul Nixon, and Deirdre Murphy, The Alfred is becoming a mecca for advanced resuscitation and ECMO/ECPR.  In this episode we sat down with Dr. Murphy to discuss the nuances of weaning a patient from ECMO.

Deirdre Murphy MB (Hons), MRCPI, FCARCSI, FCICM, DDU (Crit Care), PGDipEcho

Deirdre Murphy

Deirdre Murphy MB (Hons), MRCPI, FCARCSI, FCICM, DDU (Crit Care), PGDipEcho

Deirdre is Deputy Director ICU, Director of the Cardiothoracic ICU at The Alfred Hospital with particular interests in echocardiography and cardiac intensive care, especially mechanical circulatory supports including Ventricular Assist Devices and ECMO. Deirdre originally trained in Ireland with postgraduate training in general medicine and anaesthesia prior to undertaking intensive care training in Australia in 1999. She has been an Intensivist at The Alfred since 2003. Deirdre has been using echo in clinical practice since 2002 and heads the ICU echocardiography programme at the Alfred. She is convenor of the Alfred Critical Care Echocardiography Course and the Alfred TOE course and teaches on many of the other Alfred courses including the Ultrasound, ECMO and HeART courses.

 

Want More??

Check out Dr. Murphy’s talk from smaccGOLD on “ECMO: What could go wrong?”

Also, check out the incredible resources on ECMO on the INTENSIVE blog (the Alfred ICU Education blog)

The post EDECMO 30 – Post-Arrest ECMO Critical Care Management with Deirdre Murphy appeared first on ED ECMO.

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Post Pump Crit Care Post Pump Crit Care the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 21:29 2516
EDECMO 29 – ECMO in Hypothermic Cardiac Arrest – with Torvind Naesheim of Norway https://edecmo.org/edecmo-29-subarctic-ecmo-torvinde/ Wed, 13 Jul 2016 08:27:20 +0000 https://edecmo.org/?p=2595 https://edecmo.org/edecmo-29-subarctic-ecmo-torvinde/#respond https://edecmo.org/edecmo-29-subarctic-ecmo-torvinde/feed/ 0 <p>Joe interviews Torvind Naesheim, an intensivist and cardiothoracic anesthesiologist from Norway, on the management of accidental hypothermic arrest using ECMO</p> <p>The post <a rel="nofollow" href="https://edecmo.org/edecmo-29-subarctic-ecmo-torvinde/">EDECMO 29 – ECMO in Hypothermic Cardiac Arrest – with Torvind Naesheim of Norway</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p> Torvind Næsheim

 

 

University of North Norway, Tromso

University of North Norway, Tromso

University Hospital of North Norway:

  • located at 69 degrees North latitude – likely the northernmost ECMO center in the world.
  • The warmest month is July with a mean air temperature of 11.8C and mean sea temperature of 10.8 C.
  • The coldest month is January with a mean air temperature of -4.4 C and mean sea temperature of 5.1 C.
  • ECMO program since 1988
  • Yearly ECMO volume is approx 20 per year – including postcardiotomy support, ECPR, cardiogenic shock and respiratory failure
  • ECMO Retrieval Ambulance service: Since 12/2015: 5 ECMO transports
  • Cases are reported through the ELSO registry

Accidental Hypothermia – some definitions:
mild : 32-35 C – preserved capability to maintain core temperature through compensating thermoregulatory mechanisms
Moderate: 28-32 – loss of ability to sustain temperature via either voluntary or autonomic means
Severe: 20-28 – high risk of malignant arrhythmias
Profound: <20 Asystole

The Paper: Hilmo, J et al. Prolonged resuscitation is warranted in arrested hypothermic victims also in remote areas – A retrospective study from northern Norway. Resuscitation , Volume 85 , Issue 9 , 1204 – 1211

  • “Nobody is dead until warm and dead”
  • retrospective study looking at accidental hypothermia victims with cardiac arrest admitted to UNN between 1985-2013
  • no survivors prior to 1999
  • 1999-2013: 9/24 (37.5%) survival, defined as alive at 1 year – most with a ‘favorable' neurologic outcome
  • PRIOR studies suggested that asphyxiation, either via snow burial (avalance) or water submersion had a lower chance of survival, but this study suggests that hypothermic arrest during submersion injury may be very different. It is hypothesized that very cold temps create faster cooling rates and aspiration of cold water may induce rapid protective cerebral hypothermia. So drowning victims (asphyxia by submersion in cold water may have a higher survival)
  • Hyperkalemia is bad (>8 is bad; >12 is dead)
  • Bottom Line: “No patient is dead until they are warm and dead” – current neuroprognostication can't identify OHCA patients who may be salvageable.  So assume they are!

Key ECMO Points:

  1. Profoundly hypothermic patients cannot generate high flow rates – possibly due to increase blood viscosity.  Consider larger cannulae. Torvinde uses 29F venous and 21F arterial as a starting point.
  2. Rewarm with a veno-arterial temperature gradient of no more than 10 degrees C. Faster rewarming may result in bubble formation. Torvinde does this via the water bath heater/cooler.
  3. Therapeutic hypothermia is still in play. Torvinde holds the core temp at 36 for 24-28 hours.
  4. “You're not dead unless you're warm and dead” – consider transporting potentially salvageable patients with a reliable history.

Torvind and AnnaThe Story of Anna Bågenholm was told in this article in the Lancet:

Torvinde

 

 

 

The post EDECMO 29 – ECMO in Hypothermic Cardiac Arrest – with Torvind Naesheim of Norway appeared first on ED ECMO.

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Joe interviews Torvind Naesheim, an intensivist and cardiothoracic anesthesiologist from Norway, on the management of accidental hypothermic arrest using ECMO Joe interviews Torvind Naesheim, an intensivist and cardiothoracic anesthesiologist from Norway, on the management of accidental hypothermic arrest using ECMO the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 27:43 2595
EDECMO 28 – The University of Utah EDECMO Experience and the ERECT Collaborative https://edecmo.org/edecmo-28-utah/ Thu, 09 Jun 2016 07:59:51 +0000 https://edecmo.org/?p=2593 https://edecmo.org/edecmo-28-utah/#comments https://edecmo.org/edecmo-28-utah/feed/ 1 <p>Zack talks with the ED ECMO team from the University of Utah about how they established their ECPR program.</p> <p>The post <a rel="nofollow" href="https://edecmo.org/edecmo-28-utah/">EDECMO 28 – The University of Utah EDECMO Experience and the ERECT Collaborative</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p> The University of Utah ECPR Program

Joe TonnaJoe Tonna MD – Emergency Physician with fellowship training in intensive care, Associate Director of ECMO Services

 

Scott YoungquistScott Youngquist – Emergency Physician, Prehospital Specialist

 

Stephen McKellarSteven McKellar – CT Surgeon

 

 

 

 

 

 

Screen Shot 2016-06-08 at 11.57.19 PM

The post EDECMO 28 – The University of Utah EDECMO Experience and the ERECT Collaborative appeared first on ED ECMO.

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Zack talks with the ED ECMO team from the University of Utah about how they established their ECPR program. Zack talks with the ED ECMO team from the University of Utah about how they established their ECPR program. the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 34:46 2593
EDECMO 27 – A Real-World Case of a Crashing Multi-Drug OD Patient Saved with ED ECMO https://edecmo.org/edecmo-27-real-world-case-crashing-multi-drug-od-patient-saved-ed-ecmo/ Thu, 28 Apr 2016 07:39:47 +0000 https://edecmo.org/?p=2255 https://edecmo.org/edecmo-27-real-world-case-crashing-multi-drug-od-patient-saved-ed-ecmo/#respond https://edecmo.org/edecmo-27-real-world-case-crashing-multi-drug-od-patient-saved-ed-ecmo/feed/ 0 <p>This is a real-world case of a multi-drug overdosed patient that would have died without ECMO. We talk about ECMO being a bridge to an intervention. Well, sometimes ECMO is a bridge to metabolism of drug/med that they OD'd on.</p> <p>The post <a rel="nofollow" href="https://edecmo.org/edecmo-27-real-world-case-crashing-multi-drug-od-patient-saved-ed-ecmo/">EDECMO 27 – A Real-World Case of a Crashing Multi-Drug OD Patient Saved with ED ECMO</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p> mccollum2013

Dan McCollum MD

Dan McCollum MD
Assistant Program Residency Director at Georgia Regents University
Augusta, Georgia
Academic Medical center, Level 1 Trauma Center: census >90,000/yr

“If someone is doing an effective therapy out of the back of a truck successfully, and you can’t make it work in your hospital, then you suck and should feel bad.”

4399FE37-512B-43BE-A3D2-EBC641151B89

Case: 38 y/o female multi-drug OD on (possibly):

  1. Montelukast 10 mg (Singulair) – leukotriene receptor antagonist. mild tox profile (3698 pediatric ingestions from Texas Poison Control: 95% asymptomatic)
  2. Promethazine 25 mg (Phenergan) – Anticholinergic (56% tachycardia, 42% delirium, 2% mechanical ventilation, 1% hypotension)
  3. Cyproheptadine 4 mg  – Anticholinergic; mild tox profile (892% of OD in one case series had no or mild symptoms)
  4. Clonazepam 1 mg (Klonipin) – Common: respiratory depression and hypotension; Rare: heart block/dysrythmia
  5. Amitriptyline 25 mg – TCA – Hypotension.  QRS widening with R wave in AVR
    • Treatment:
      • antidote = sodium bicarbonate
      • crystalloid for hypotension
      • Pressors for refractory hypotension
  6. Amlodipine 5 mg – Calcium Channel Blocker – Common: Bradycardia, hypotension, heart block; Rare: apnea, pulmonary edema, ARDS, coma, Lactica acidosis, hypoerglycemia, bowel infarction
    • Treatment:
      1. IVF
      2. High Dose Calcium (inotrope)
      3. Pressors – Isoproterenol
      4. Glucagon
      5. Atropine
      6. High Dose Insulin – 1-10 unit/kg/hr infusion (consider simultaneous glucose infusion)

 

Timeline before ECMO:

  • 02:00-17:00     Estimated time of ingestion:  (2-15 hours PTA).
  • 19:00                 Presentation to ED
  • 19:30                 BP 55/33; sats 93% on 60% FiO2
  • 19:41                  PEA ARREST #1
    • Epinephrine, Atropine, Sodium Bicarbonate, Calcium Gluconate, D50
    • Narcan > No response
  • 19:54                  Bradycardia with pulse
  • 20:10                  Bicarbonate gtt
  • 20:15                  Epinephrine gtt
  • 20:18                  High Dose Insulin bolus, then gtt
  • 20:31                  TC pacing
  • 20:40                 Norepi gtt, Charcoal
  • 20:46                 CXR = pulmonary edema
  • 21:07                  Bivent initiation
  • 21:14                  Intralipid bolus
  • 21:16                  Glucagon
  • 21:21                  43/29 with sats 69% and pulse 70
  • 21:31                 pRBC transfusion initiated

3433685E-8535-4A3A-B5F2-001738A76FB4

Total Meds used in resuscitation:

  • Calcium Gluconate:                21 Amps
  • Sodium Bicarbonate:             19 Ams
  • Epinephrine:                           9.5 mg + drips
  • Insulin:                                     ~150 units

Complications during hospitalization (but the patient is alive!):

  1. AF with RVR
  2. DVT
  3. ipsilateral limb ischemia > Necrotizing fasciitis > AKA
  4. Pleural Effusion > chest tube
  5. Bowel perforation (due to ischemia) > laparotomy
  6. Trach/PEG
  7. Abdominal Wall Abscess > I&D

A4DB2CFD-D125-4CA1-9363-DA61E1E801C8

Learning Points:

  1. RUSH exam early for undifferentiated shock
  2. Restrictive lung strategy to avoid ARDS
  3. Multi-agent OD: contact Poison Control – they can actually help! 1-800-411-8080
  4. ECMO is a bridge to metabolism/recovery.

“If someone is doing an effective therapy out of the back of a truck successfully, and you can’t make it work in your hospital, then you suck and should feel bad.” – Dan

*and special thanks to Dan McCollum for creating and sharing the Napoleon Dynomite memes.

The post EDECMO 27 – A Real-World Case of a Crashing Multi-Drug OD Patient Saved with ED ECMO appeared first on ED ECMO.

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This is a real-world case of a multi-drug overdosed patient that would have died without ECMO. We talk about ECMO being a bridge to an intervention. Well, sometimes ECMO is a bridge to metabolism of drug/med that they OD'd on. This is a real-world case of a multi-drug overdosed patient that would have died without ECMO. We talk about ECMO being a bridge to an intervention. Well, sometimes ECMO is a bridge to metabolism of drug/med that they OD'd on. the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 34:22 2255
EDECMO 26 – “ECPR is a Step Too Far” – Ho vs. Bellezzo: a SMACCback Chicago Cage Match https://edecmo.org/edecmo-26-ecpr-is-a-step-too-far-ho-vs-bellezzo-a-smacc-chicago-cage-match/ Wed, 02 Mar 2016 05:50:00 +0000 https://edecmo.org/?p=2483 https://edecmo.org/edecmo-26-ecpr-is-a-step-too-far-ho-vs-bellezzo-a-smacc-chicago-cage-match/#comments https://edecmo.org/edecmo-26-ecpr-is-a-step-too-far-ho-vs-bellezzo-a-smacc-chicago-cage-match/feed/ 4 <p>Are you ready for this rumble in the urban jungle?? Chris Ho vs Joe Bellezzo in the no holds barred debate about whether ECMO CPR is a step too far? The next cage match from SMACC Chicago.</p> <p>The post <a rel="nofollow" href="https://edecmo.org/edecmo-26-ecpr-is-a-step-too-far-ho-vs-bellezzo-a-smacc-chicago-cage-match/">EDECMO 26 – “ECPR is a Step Too Far” – Ho vs. Bellezzo: a SMACCback Chicago Cage Match</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p> CHRIS HO VS JOE BELLEZZO – ECPR IS A STEP TOO FAR

***republished with permission from the SMACC team from: http://www.smacc.net.au/2016/02/chris-ho-vs-joe-bellezzo-ecpr-is-a-step-too-far/

Are you ready for this rumble in the urban jungle?? Chris Ho vs Joe Bellezzo in the no holds barred debate about whether ECMO CPR is a step too far? The next cage match from SMACC Chicago.

Chris and Joe are the director and vice-director respectively, of Emergency Medicine at Sharp Memorial Hospital in San Diego, California. They are two of the leading experts in ECPR, with Joe being one of the key players behind EDECMO. On a day-to-day basis, they are friends and colleagues, working together in one of the very few centers around the world to deliver ECPR. However in this Cage Match, friends become foe and there are no limitations to how far each will go to prove their side of the debate.

On the AFFIRMATIVE side, Chris Ho delivers a convincing argument for why ECPR IS a step too far. From lack of evidence to the cost of “re-animating the dead” and everything in between, Chris Ho delivers a practical approach to the argument and demonstrates without a doubt why we are not ready for this to be the next step in resuscitation.

On the NEGATIVE side, Joe Bellezzo delivers an outstanding rebuttal to “Dr Ho’s Nutty Brown Bullshit”. In an inspiring argument filled with anecdotes and occasional facts, Joe Bellezzo makes it impossible to think the ECPR shouldn’t be the next step in our ALS algorithm,

Despite strong arguments from either side, as in all debates, there must be a winner. Do you agree with the outcome?

If you want to find out whether Chris and Joe were able to kiss and make up, check out the exclusive ICN interview with the two, where they discuss more on ECPR.

Also check out the ‘SMACCback' interview of Ho and Bellezzo by Sophie Connolly and Alice Young of the SMACC Chicago team:

Ho-bellezzo-SMACC-CHICAGO-THE-INTERVIEWS

The post EDECMO 26 – “ECPR is a Step Too Far” – Ho vs. Bellezzo: a SMACCback Chicago Cage Match appeared first on ED ECMO.

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Are you ready for this rumble in the urban jungle?? Chris Ho vs Joe Bellezzo in the no holds barred debate about whether ECMO CPR is a step too far? The next cage match from SMACC Chicago. Are you ready for this rumble in the urban jungle?? Chris Ho vs Joe Bellezzo in the no holds barred debate about whether ECMO CPR is a step too far? The next cage match from SMACC Chicago. the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 30:00 2483
EDECMO 25.5 – (Part 2) an EDECMO short with Jim Manning – on location with the SAMU pre-hospital ECMO team in France https://edecmo.org/edecmo-25-5/ Mon, 30 Nov 2015 06:55:59 +0000 https://edecmo.org/?p=2367 https://edecmo.org/edecmo-25-5/#comments https://edecmo.org/edecmo-25-5/feed/ 2 <p>In followup to our discussion with Jim Manning MD (@JManning_UNC) and Lionel Lamhaut (@LionelLamhaut) MD of the Service d’Aide Médicale Urgente (SAMU) for EDECMO Episode 25, the guys spent the last few days 'just hanging out in Paris."</p> <p>The post <a rel="nofollow" href="https://edecmo.org/edecmo-25-5/">EDECMO 25.5 – (Part 2) an EDECMO short with Jim Manning – on location with the SAMU pre-hospital ECMO team in France</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p> In followup to our discussion with Jim Manning MD (@JManning_UNC)  and Lionel Lamhaut (@LionelLamhaut) MD of the Service d’Aide Médicale Urgente (SAMU) for EDECMO Episode 25, the guys spent the last few days ‘just hanging out in Paris.”

The recent massacre in Paris certainly makes this topic..well…topical.

Manning spent several days with the prehospital ECMO team in France.  In this episode Zack interviewed Manning, who was on-location with the SAMU in France…and walks us through the experience of witnessing prehospital ECMO with the SAMU.

In the U.S., we aren't yet ready for pre-hospital endovascular resuscitation – indeed there are currently several barriers to overcome. But perhaps the Europeans are onto something here:

Femoral cutdown vs. percutaneous access? Discussed. Verdict?

Transporting a patient on ECMO:

You know, the thing is…that once you have a patient on ECMO, everything chills out…

-Jim Manning

Every patient gets:

  • Dobutamine: 5 ug/kg/min
  • Norepinephrine 3 mg/hr
  • pRBC 2 units
  • FFP 2 units

Flow goals: start 2.5-3 lpm…then slowly increase. Does this help quell reperfusion injury?

This is the exciting. This is fantastic. This is the future if you ask me. We are going to be doing this and its just a matter of time before the rest of us realize that…we are headed in the right direction

Jim Manning

Jim Manning

SAMU Ambulance

SAMU Ambulance

Lionel Lamhaut and the SAMU ambulance

Lionel Lamhaut and the SAMU ambulance

Manning & SAMU

Manning & SAMU

The post EDECMO 25.5 – (Part 2) an EDECMO short with Jim Manning – on location with the SAMU pre-hospital ECMO team in France appeared first on ED ECMO.

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In followup to our discussion with Jim Manning MD (@JManning_UNC) and Lionel Lamhaut (@LionelLamhaut) MD of the Service d’Aide Médicale Urgente (SAMU) for EDECMO Episode 25, the guys spent the last few days 'just hanging out in Paris." In followup to our discussion with Jim Manning MD (@JManning_UNC) and Lionel Lamhaut (@LionelLamhaut) MD of the Service d’Aide Médicale Urgente (SAMU) for EDECMO Episode 25, the guys spent the last few days 'just hanging out in Paris." the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 18:18 2367
EDECMO 25 – ‘Ze ECMO TEAM.’ Manning and Lamhaut: Updates on ECMO, the new 7F REBOA Catheter, and Pre-hospital ECMO in France https://edecmo.org/edecmo-25-ze-ecmo-team-manning-and-lamhaut-updates-on-ecmo-the-new-7f-reboa-catheter-and-pre-hospital-ecmo-in-france/ Thu, 19 Nov 2015 08:53:27 +0000 https://edecmo.org/?p=2345 https://edecmo.org/edecmo-25-ze-ecmo-team-manning-and-lamhaut-updates-on-ecmo-the-new-7f-reboa-catheter-and-pre-hospital-ecmo-in-france/#comments https://edecmo.org/edecmo-25-ze-ecmo-team-manning-and-lamhaut-updates-on-ecmo-the-new-7f-reboa-catheter-and-pre-hospital-ecmo-in-france/feed/ 4 <p>In this episode, Zack interviews Jim Manning MD (University of North Carolina) and Dr. Lionel Lamhaut from the famed French SAMU (Service d'Aide Médicale Urgente). REBOA. SAAP. Pre-Hospital ECMO. Its all here.</p> <p>The post <a rel="nofollow" href="https://edecmo.org/edecmo-25-ze-ecmo-team-manning-and-lamhaut-updates-on-ecmo-the-new-7f-reboa-catheter-and-pre-hospital-ecmo-in-france/">EDECMO 25 – ‘Ze ECMO TEAM.’ Manning and Lamhaut: Updates on ECMO, the new 7F REBOA Catheter, and Pre-hospital ECMO in France</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p> In this episode, Zack interviews Jim Manning MD (University of North Carolina) and Dr. Lionel Lamhaut of the famed French SAMU (Service d'Aide Médicale Urgente).

Highlights:

2015 Resuscitation Science Symposium updates:

“ECMO is at the forefront of resuscitation science” – Jim Manning

The New REBOA Catheter: Pryor Medical – just obtained FDA approval for endovascular proximal control of non-compressible hemorrhage below the diaphragm.

At Sharp Memorial Hospital we currently use the 12Fr Chek-Flo sheath, paired with 12F (external diameter) CODA balloon occlusion catheter for non-compressible hemorrhage below the diaphragm.  Pryor Medical has just gained FDA approval to market their REBOA catheter – a 7F version that doesn't seem to require surgical repair of the arteriotomy site.  For those of us doing REBOA, this is a BIG DEAL:

Website Image 10-26-15

Selective Aortic Arch Perfusion Catheter (SAAP) – which is like a REBOA catheter but has a lumen large enough to perfuse blood (or a blood substitute) through.  Manning talks about what's sexy with his device.

 

Lionel Lamhaut from the French SAMU (Service d'Aide Médicale Urgente) gives us an update on their prehospital ECMO program in France:

SAMU Inclusion Criteria:

  1. Medical Cardiac Arrest
  2. Age < 75
  3. No Flow < 5 min (bystander CPR must be started within 5 min)
  4. Hypothermia is always considered
  5. Intoxications (of any kind) are always considered
  6. ETCO2 > 10

For review, check out our original discussion with ‘reanimateur' Dr. Lamhaut about prehospital ECMO: edecmo.org/17

In keeping with all of the in-hospital and out-of-hospital ECPR data accumulating, it appears that Lamhaut's team is also seeing a success rate (survival with CPC 1 or 2) of around 30% (final data pending publication).

 

Consider this: the modified cut-down technique. The French prehospital team, quite obviously, don't have ultrasound access in the field.  So instead of using ultrasound visualization of the femoral vessels, they necessarily use direct visualization.  Listen to this episode to hear the details…

 

 

 

 

The post EDECMO 25 – ‘Ze ECMO TEAM.’ Manning and Lamhaut: Updates on ECMO, the new 7F REBOA Catheter, and Pre-hospital ECMO in France appeared first on ED ECMO.

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In this episode, Zack interviews Jim Manning MD (University of North Carolina) and Dr. Lionel Lamhaut from the famed French SAMU (Service d'Aide Médicale Urgente). REBOA. SAAP. Pre-Hospital ECMO. Its all here. In this episode, Zack interviews Jim Manning MD (University of North Carolina) and Dr. Lionel Lamhaut from the famed French SAMU (Service d'Aide Médicale Urgente). REBOA. SAAP. Pre-Hospital ECMO. Its all here. the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 15:04 2345
The Rat Pack: Another Year of EDECMO (2014/2015) – Video https://edecmo.org/the-rat-pack-another-year-of-edecmo-20142015-video/ Sun, 04 Oct 2015 03:25:17 +0000 https://edecmo.org/?p=2298 https://edecmo.org/the-rat-pack-another-year-of-edecmo-20142015-video/#comments https://edecmo.org/the-rat-pack-another-year-of-edecmo-20142015-video/feed/ 1 <p>The Rat Pack: The Last Year of EDECMO!</p> <p>The post <a rel="nofollow" href="https://edecmo.org/the-rat-pack-another-year-of-edecmo-20142015-video/">The Rat Pack: Another Year of EDECMO (2014/2015) – Video</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p> The post The Rat Pack: Another Year of EDECMO (2014/2015) – Video appeared first on ED ECMO.

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The Rat Pack: The Last Year of EDECMO! The Rat Pack: The Last Year of EDECMO! the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 1:59 2298
EDECMO 24 – Weaning VA-ECMO, with Deirdre Murphy https://edecmo.org/edecmo-24-weaning-va-ecmo-with-deirdre-murphy/ Thu, 10 Sep 2015 04:01:52 +0000 https://edecmo.org/?p=2245 https://edecmo.org/edecmo-24-weaning-va-ecmo-with-deirdre-murphy/#comments https://edecmo.org/edecmo-24-weaning-va-ecmo-with-deirdre-murphy/feed/ 13 <p>In this episode, Zack and Joe talk with Deirdre Murphy, the Deputy Director of the ICU, director of the cardiothoracic ICU at the Alfred Hospital in Melbourne, Australia. The Alfred has put itself on the map in so many ways over the past decade. Home to Stephen Bernard (of the original Hypothermia after ROSC without RONF fame), Chris Nickson (@precordialthump, @I_C_N, @intensiveblog, #SMACC, lifeinthefastlane.com), and good friends Jason McClue, Steve McGloughlin, Josh Ihle, Paul Nixon, and Deirdre Murphy, The Alfred is becoming a mecca for advanced resuscitation and ECMO/ECPR. In this episode we sat down with Dr. Murphy to discuss the nuances of weaning a patient from ECMO.</p> <p>As ED Docs, Zack and I find ourselves at the heroic end of the resuscitation spectrum when the dying patient goes on pump...but what happens at the other end? What happens in the hours, days, and weeks that follow? Listen to this episode to find out...</p> <p>The post <a rel="nofollow" href="https://edecmo.org/edecmo-24-weaning-va-ecmo-with-deirdre-murphy/">EDECMO 24 – Weaning VA-ECMO, with Deirdre Murphy</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p> In this episode, Zack and Joe talk with Deirdre Murphy, the Deputy Director of the ICU, director of the cardiothoracic ICU at the Alfred Hospital in Melbourne, Australia. The Alfred has put itself on the map in so many ways over the past decade. Home to Stephen Bernard (of the original Hypothermia after ROSC without RONF fame), Chris Nickson (@precordialthump, @ragepodcast, @intensiveblog, #SMACC, lifeinthefastlane.com), and good friends Jason McClure, Steve McGloughlin, Josh Ihle, Paul Nixon, and Deirdre Murphy, The Alfred is becoming a mecca for advanced resuscitation and ECMO/ECPR.  In this episode we sat down with Dr. Murphy to discuss the nuances of weaning a patient from ECMO.

As ED Docs, Zack and I find ourselves at the heroic end of the resuscitation spectrum when the dying patient goes on pump…but what happens at the other end? What happens in the hours, days, and weeks that follow?  Listen to this episode to find out…

 

Deirdre Murphy MB (Hons), MRCPI, FCARCSI, FCICM, DDU (Crit Care), PGDipEcho

Deirdre Murphy MB (Hons), MRCPI, FCARCSI, FCICM, DDU (Crit Care), PGDipEcho

Deirdre Murphy MB (Hons), MRCPI, FCARCSI, FCICM, DDU (Crit Care), PGDipEcho

Deirdre is Deputy Director ICU, Director of the Cardiothoracic ICU at The Alfred Hospital with particular interests in echocardiography and cardiac intensive care, especially mechanical circulatory supports including Ventricular Assist Devices and ECMO. Deirdre originally trained in Ireland with postgraduate training in general medicine and anaesthesia prior to undertaking intensive care training in Australia in 1999. She has been an Intensivist at The Alfred since 2003. Deirdre has been using echo in clinical practice since 2002 and heads the ICU echocardiography programme at the Alfred. She is convenor of the Alfred Critical Care Echocardiography Course and the Alfred TOE course and teaches on many of the other Alfred courses including the Ultrasound, ECMO and HeART courses.

A paper just published in Intensive Care Medicine followed this algorithm:

(Intensive Care Med (2015) 41:902-905)

How to wean a patient from veno-arterial extracorporeal membrane oxygenation

Screen Shot 2015-09-07 at 12.26.16 PM

Some Notes

Signs of improvement

  • Pulsatility indicates the patient is getting better
  • ETCO2 starts to rise
  • Weaning Vasopressors

 

Want More??

Check out Dr. Murphy's talk from smaccGOLD on “ECMO: What could go wrong?”

Also, check out the incredible resources on ECMO on the INTENSIVE blog (the Alfred ICU Education blog)

Update:

Can we use ETCO2 to assess weaning?

snag-0002-2

 

The post EDECMO 24 – Weaning VA-ECMO, with Deirdre Murphy appeared first on ED ECMO.

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In this episode, Zack and Joe talk with Deirdre Murphy, the Deputy Director of the ICU, director of the cardiothoracic ICU at the Alfred Hospital in Melbourne, Australia. The Alfred has put itself on the map in so many ways over the past decade. In this episode, Zack and Joe talk with Deirdre Murphy, the Deputy Director of the ICU, director of the cardiothoracic ICU at the Alfred Hospital in Melbourne, Australia. The Alfred has put itself on the map in so many ways over the past decade. Home to Stephen Bernard (of the original Hypothermia after ROSC without RONF fame), Chris Nickson (@precordialthump, @I_C_N, @intensiveblog, #SMACC, lifeinthefastlane.com), and good friends Jason McClue, Steve McGloughlin, Josh Ihle, Paul Nixon, and Deirdre Murphy, The Alfred is becoming a mecca for advanced resuscitation and ECMO/ECPR. In this episode we sat down with Dr. Murphy to discuss the nuances of weaning a patient from ECMO.<br /> <br /> As ED Docs, Zack and I find ourselves at the heroic end of the resuscitation spectrum when the dying patient goes on pump...but what happens at the other end? What happens in the hours, days, and weeks that follow? Listen to this episode to find out... the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 35:08 2245
EDECMO 23 – ORNATO LIVES! – How ECMO Saved a Pillar of Resuscitation https://edecmo.org/edecmo-23-ornato-lives-how-ecmo-saved-a-pillar-of-resuscitation/ Tue, 14 Jul 2015 17:00:44 +0000 https://edecmo.org/?p=2150 https://edecmo.org/edecmo-23-ornato-lives-how-ecmo-saved-a-pillar-of-resuscitation/#comments https://edecmo.org/edecmo-23-ornato-lives-how-ecmo-saved-a-pillar-of-resuscitation/feed/ 1 <p>Joe Ornato, a pillar in the world of resuscitation, suffered a massive PE and arrested upon arrival to the Virginia Commonwealth University Emergency Department in April 2015. How it all unfolded is amazing. Listen to this episode to hear the details...</p> <p>The post <a rel="nofollow" href="https://edecmo.org/edecmo-23-ornato-lives-how-ecmo-saved-a-pillar-of-resuscitation/">EDECMO 23 – ORNATO LIVES! – How ECMO Saved a Pillar of Resuscitation</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p> Dept of Emergency Medicine_Joseph Ornato_MD

Dept of Emergency Medicine. Joseph Ornato MD

“They RSI'd me…they cannulated me…

Here I am today, two months later…”

Joe Ornato, a pillar in the world of resuscitation, suffered a massive PE and arrested upon arrival to the Virginia Commonwealth University Emergency Department in April 2015.  First: hats off!!! to the Emergency Department, the resuscitation team, the CT surgeons and entire staff at VCU. How it all unfolded is amazing! You MUST listen to this episode to hear the details…

Joseph P. Ornato, MD, FACP, FACC, FACEP

Dr. Joseph P. Ornato is professor and chairman of the Department of Emergency Medicine at Virginia Commonwealth University Medical Center in Richmond, Virginia. He is also medical director of the Richmond Ambulance Authority, the Prehospital Paramedic System serving Richmond, Va. Dr. Ornato is triple board certified (internal medicine, cardiology, emergency medicine) and is an active researcher in the field of cardiopulmonary resuscitation. Dr. Ornato is an editor of the journal Resuscitation. He is past Chairman of the American Heart Association's (AHA) National Emergency Cardiovascular Care Committee and its Advanced Cardiac Life Support Subcommittee. He chaired the National Steering Committee on the NIH Public Access Defibrillation Trial. He is currently consultant and cardiac co-chairman of the NIH Resuscitation Outcomes Consortium (ROC) and serves as principal investigator for VCU on the NIH-sponsored Neurological Emergency Treatment Trials (NETT) Network. Dr. Ornato is a member of the Institute of Medicine.

Ornato and EMS team

Dr. Ornato and the prehospital trauma team

joe-ornato-photo-4_10937792

 

We lose the equivalent of one medium sized American city to the problem of sudden, unexpected cardiac arrest each year. The best weapon we have against this killer is early defibrillation. We need to move quickly to saturate the chain of survival, particularly the early defibrillation  component, in every community.”

-Joe Ornato, MD, FACC, FACEP

The post EDECMO 23 – ORNATO LIVES! – How ECMO Saved a Pillar of Resuscitation appeared first on ED ECMO.

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Joe Ornato, a pillar in the world of resuscitation, suffered a massive PE and arrested upon arrival to the Virginia Commonwealth University Emergency Department in April 2015. How it all unfolded is amazing. Listen to this episode to hear the details... Joe Ornato, a pillar in the world of resuscitation, suffered a massive PE and arrested upon arrival to the Virginia Commonwealth University Emergency Department in April 2015. How it all unfolded is amazing. Listen to this episode to hear the details... the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 22:25 2150
EDECMO 22 – Managing the Crashing Tox Patient with ECMO – with Leon Gussow & Steve Aks from The Poison Review https://edecmo.org/edecmo-22-managing-the-crashing-tox-patient-with-ecmo-with-leon-gussow-steve-aks-from-the-poison-review/ Mon, 15 Jun 2015 12:00:26 +0000 https://edecmo.org/?p=2027 https://edecmo.org/edecmo-22-managing-the-crashing-tox-patient-with-ecmo-with-leon-gussow-steve-aks-from-the-poison-review/#comments https://edecmo.org/edecmo-22-managing-the-crashing-tox-patient-with-ecmo-with-leon-gussow-steve-aks-from-the-poison-review/feed/ 2 <p>In this episode Scott, Zack and Joe were all in the same room...in a conference room at the University of North Carolina, Chapel Hill - where we were doing ECPR studies in an animal model of cardiac arrest with Jim Manning. We spoke with legendary toxicologists Leon Gussow and Steve Aks about the role of ECMO and ECPR in the overdosed tox patient.</p> <p>The post <a rel="nofollow" href="https://edecmo.org/edecmo-22-managing-the-crashing-tox-patient-with-ecmo-with-leon-gussow-steve-aks-from-the-poison-review/">EDECMO 22 – Managing the Crashing Tox Patient with ECMO – with Leon Gussow & Steve Aks from The Poison Review</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p>  

…the key thing is to put them on ECMO when they need it, but not a minute sooner!

-Leon Gussow

In this episode Scott, Zack and Joe were all in the same room…in a conference room at the University of North Carolina, Chapel Hill – where we were doing ECPR studies in an animal model of cardiac arrest with Jim Manning. We spoke with legendary toxicologists Leon Gussow and Steve Aks about the role of ECMO and ECPR in the overdosed tox patient.

This is a fascinating discussion about the nuances of ECMO in the crashing intoxicated patient.

Check out THE POISON REVIEW and Subscribe to them in iTunes

GussowLeon Gussow MD,

University of Illinois Medical Center, Chicago
John H. Stroger Jr. Hospital of Cook County
Emergency Medicine News “Toxicology Rounds”
Medical Editor of ‘The Poison Review”

aks-1-186x250

Steve Aks DO, FACMT, FACOEP, FACEP

Director, Toxicology Fellowship Program, Department of Emergency Medicine, Cook County Health and Hospitals System


 

Some Unique Situations:

ECMO and intralipid?

  • What are the adverse effects associated with the combined use of intravenous lipid emulsion and extracorporeal membrane oxygenation in the poisoned patient. Clin Toxicol (Phila). 2015 Mar;53(3):145-50. doi: 10.3109/15563650.2015.1004582. Epub 2015 Jan 29.
  • Bolus dose intralipid before ECMO is reasonable and should not result in significant pump complications with our current oxygenators.  However, starting intra-lipid after the patient is on bypass won't likely provide much more benefit and could shorten the life of your oxygenator.

ECMO and Dialysis?

  • Hemodialysis can be done in-line with the ECMO circuit, but its preferred to use a separate dialysis catheter placed at a remote site (ie the IJ).  A dialysis circuit CAN be spliced into the ECMO circuit, but is a little more complicated.

Mitochondrial and Cellular Respiration Poisons (dinitrophenol & Cyanid) and Carbon Monoxide?

  • ECMO is of NO USE in these intoxications.

The post EDECMO 22 – Managing the Crashing Tox Patient with ECMO – with Leon Gussow & Steve Aks from The Poison Review appeared first on ED ECMO.

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In this episode Scott, Zack and Joe were all in the same room...in a conference room at the University of North Carolina, Chapel Hill - where we were doing ECPR studies in an animal model of cardiac arrest with Jim Manning. In this episode Scott, Zack and Joe were all in the same room...in a conference room at the University of North Carolina, Chapel Hill - where we were doing ECPR studies in an animal model of cardiac arrest with Jim Manning. We spoke with legendary toxicologists Leon Gussow and Steve Aks about the role of ECMO and ECPR in the overdosed tox patient. the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 33:37 2027
REANIMATE SAN DIEGO 2016: February 25-26, 2016 https://edecmo.org/reanimate-san-diego-2016-february-25-26-2016/ Mon, 25 May 2015 06:54:35 +0000 https://edecmo.org/?p=2051 https://edecmo.org/reanimate-san-diego-2016-february-25-26-2016/#respond https://edecmo.org/reanimate-san-diego-2016-february-25-26-2016/feed/ 0 <p>REANIMATE is a 2-day conference that will teach you everything about Resuscitative ECMO and Extracorporeal Cardiopulmonary Resuscitation (ECPR). The conference will be hosted by Zack Shinar, Scott Weingart, and Joe Bellezzo</p> <p>The post <a rel="nofollow" href="https://edecmo.org/reanimate-san-diego-2016-february-25-26-2016/">REANIMATE SAN DIEGO 2016: February 25-26, 2016</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p> REANIMATE SAN DIEGO 2016:       February 25-26, 2016 in beautiful San Diego, California, USA.

ABOUT THE CONFERENCE:

REANIMATE is a 2-day conference that will teach you everything about Resuscitative ECMO and Extracorporeal Cardiopulmonary Resuscitation (ECPR). Multidisciplinary teamwork and human factors will be stressed throughout. Sessions will have a heavy emphasis on acquiring hands-on skills associated with initiation of ECMO including:

  • Cannulation Technique
  • ECMO Physiology
  • Pump Troubleshooting
  • Cardiac Arrest & Peri-ECMO Resuscitation

ABOUT THE FACULTY:

The REANIMATE faculty will include some of the brightest minds in all of Resuscitation Medicine. The EDECMO team will be joined by some of the best teachers in the ECMO world. Check out the Faculty Page to see more about our incredible professors. Also check out the Schedule of Events.

ABOUT THE LOCATION

REANIMATE will be held at the UCSD Simulation Center in San Diego, California. The Sim Center offers gorgeous classrooms and state of the art simulation capabilities. The surrounding area is amazing. Torrey Pines golf course and recreation center are a short walk away. Beaches with surfing, volleyball and swimming are also within 3 miles of the Sim Center. The conference will make use of these areas with a beach trip and hiking of Torrey Pines on the agenda.UCSD Med Ed buildingvode_ucsd_telemed_01-resized-600

 

February is one of the most beautiful times of the year to visit San Diego.  Bring the family and make it a vacation!

REGISTER TODAY! space is limited

The post REANIMATE SAN DIEGO 2016: February 25-26, 2016 appeared first on ED ECMO.

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REANIMATE is a 2-day conference that will teach you everything about Resuscitative ECMO and Extracorporeal Cardiopulmonary Resuscitation (ECPR). The conference will be hosted by Zack Shinar, Scott Weingart, and Joe Bellezzo REANIMATE is a 2-day conference that will teach you everything about Resuscitative ECMO and Extracorporeal Cardiopulmonary Resuscitation (ECPR). The conference will be hosted by Zack Shinar, Scott Weingart, and Joe Bellezzo the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 1:35 2051
EDECMO 21- The Vienna Project: A Randomized-Controlled Trial of ECPR for Out-Of-Hospital Cardiac Arrest https://edecmo.org/edecmo-21-the-vienna-project-a-randomized-controlled-trial-of-ecpr-for-out-of-hospital-cardiac-arrest/ Thu, 21 May 2015 00:02:23 +0000 https://edecmo.org/?p=1996 https://edecmo.org/edecmo-21-the-vienna-project-a-randomized-controlled-trial-of-ecpr-for-out-of-hospital-cardiac-arrest/#comments https://edecmo.org/edecmo-21-the-vienna-project-a-randomized-controlled-trial-of-ecpr-for-out-of-hospital-cardiac-arrest/feed/ 2 <p>In this episode Zack talks with Dr. Schoeber about their newest endeavor, the holy grail: a randomized-controlled trial comparing "Load & Go" (transporting OHCA patients to the ED immediately for consideration of ECMO) vs. "standard care" (staying on scene until the patient achieves either ROSC or is pronounced dead). Zack and Andreas talk about the impact this could have on the future of ECPR for OHCA.</p> <p>The post <a rel="nofollow" href="https://edecmo.org/edecmo-21-the-vienna-project-a-randomized-controlled-trial-of-ecpr-for-out-of-hospital-cardiac-arrest/">EDECMO 21- The Vienna Project: A Randomized-Controlled Trial of ECPR for Out-Of-Hospital Cardiac Arrest</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p>
SchoberAndreas Schober is an Emergency Medicine physician and resuscitationist from the Medical University of Vienna. Dr. Schober is a world-expert in resuscitation, ECPR, and cardiac arrest. We met Schober in Chicago at the 2014 American Heart Association (AHA) Resuscitation Symposium (ReSS) where he presented their experience with a “Load & Go” model for out-of-hospital cardiac arrest (OHCA): Screen Shot 2015-05-01 at 10.08.03 PM


In this episode Zack talks with Dr. Schoeber about their newest endeavor, the holy grail: a randomized-controlled trial comparing “Load & Go” (transporting OHCA patients to the ED immediately for consideration of ECMO) vs. “standard care” (staying on scene until the patient achieves either ROSC or is pronounced dead).  Zack and Andreas talk about the impact this could have on the future of ECPR for OHCA.

Announcements:

SMACC Chicago 2015: There is still time to register for SMACC – the biggest and baddest ED Critical Care conference in the World. Just check out the lineup of speakers! You won't want to miss this.

Reanimate San Diego 2016:  The EDECMO team has put together a crew of world-class educators to teach you how to set up an ED ECMO program, teach you how to initiate ECPR in arresting patients, and teach you how to manage patients after they are on “on-pump”. Please join us in “America's Finest City,” San Diego, California, for 2-day immersion in ECPR. We are limiting the conference size to maximize your learning experience, so registration will sell out quickly:

Register for Reanimate San Diego 2016

 

**Special thanks to Camille Hudon for providing the “International Introduction”, in French, to this episode!!!  That was recorded in a small restaurant in Montreal during Bring Me Back To Life 2014

 

 

The post EDECMO 21- The Vienna Project: A Randomized-Controlled Trial of ECPR for Out-Of-Hospital Cardiac Arrest appeared first on ED ECMO.

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In this episode Zack talks with Dr. Schoeber about their newest endeavor, the holy grail: a randomized-controlled trial comparing "Load & Go" (transporting OHCA patients to the ED immediately for consideration of ECMO) vs. In this episode Zack talks with Dr. Schoeber about their newest endeavor, the holy grail: a randomized-controlled trial comparing "Load & Go" (transporting OHCA patients to the ED immediately for consideration of ECMO) vs. "standard care" (staying on scene until the patient achieves either ROSC or is pronounced dead). Zack and Andreas talk about the impact this could have on the future of ECPR for OHCA. the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 16:42 1996
EDECMO 20 – The Golden Hour & the Rule of 3’s: Optimizing the Critical First Hour on Heart-Lung Bypass https://edecmo.org/edecmo-20-the-golden-hour-the-rule-of-3s-optimizing-the-critical-first-hour-on-heart-lung-bypass/ Sat, 11 Apr 2015 21:15:57 +0000 https://edecmo.org/?p=1956 https://edecmo.org/edecmo-20-the-golden-hour-the-rule-of-3s-optimizing-the-critical-first-hour-on-heart-lung-bypass/#comments https://edecmo.org/edecmo-20-the-golden-hour-the-rule-of-3s-optimizing-the-critical-first-hour-on-heart-lung-bypass/feed/ 2 <p>In this episode, Joe talks about that first critical hour on Heart-Lung Bypass. What are the most common and critical clinical scenarios that the ECMO operator faces in that first hour on pump? Listen to this episode to find out. </p> <p>The post <a rel="nofollow" href="https://edecmo.org/edecmo-20-the-golden-hour-the-rule-of-3s-optimizing-the-critical-first-hour-on-heart-lung-bypass/">EDECMO 20 – The Golden Hour & the Rule of 3’s: Optimizing the Critical First Hour on Heart-Lung Bypass</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p> Announcements

Upcoming Conferences:

  1. SMACC 2015: June 23-26, 2015. The biggest and baddest critical care conference of the year is in Chicago this year.
  2. Essentials of Emergency Medicine 2015. October 13-15, 2015. The Big Show. In Vegas. At the Cosmopolitan.
  3. Reanimate San Diego. February 25-26, 2016. The essentials of ECMO in 2 glorious days. Here is a sneak peak at the Reanimate 2016 Promo Video.

Flipped Classroom SMACC ECMO Workshop 2015

For those taking the upcoming ECMO courses with us, download both of these 2 attachments. The first is a diagram of a traditional ECMO circuit – its nice to print this out and follow along. Not every circuit is the same and we have ours custom built by Maquet.  The second is a self-study course.  While it isn't necessary to review these before our workshop, it will really put you ahead of the game and we focus more on procedures.

Custom Maquet Circuit

Figure 1. The Custom Maquet ECMO Circuit

Study Guide

Screen Shot 2015-04-04 at 11.04.36 PM

Review of the 3 stages of ECPR

  1. STAGE 1: Placement of any commercially available vascular catheter in the femoral vein and femoral artery
  2. STAGE 2: Replacement of each catheter with ECMO cannulae. Checkout EDECMO 5: Cognitive Task Management for ED ECMO Stages 1 and 2. Also, we learned several cannulation pearls from Stephen Bernard in EDECMO 14 Part 1 and Part 2
  3. STAGE 3: Initiation of Total Heart Lung Bypass

ECMO Circuit Setup:

  1. Plug in the machine and power-on the heater-cooler and the Rotaflow console.
  2. Unpackage the circuit and hold it up to orient yourself.
  3. Mounting the Rotaflow Pump to the Pump Drive

    Mounting the Rotaflow Pump to the Pump Drive

    Attach the Oxygenator to the bracket and the pump to the pump-drive; hang the distal ends of the circuit (the tubes that will connect to the patient) from the IV pole.

  4. Apply ultrasonic contact cream to the flow probe contact site
  5. Remove and DISCARD the yellow de-airing exit port cap on the top of the oxygenator.
  6. Connect the water lines from the heater-cooler to the Quadrox Oxygenator & open the stopcocks.
  7. “Run the circuit”, making sure that the recirculation bridge is OPEN, arterial and venous tubing is CLAMPED, rapid-prime tubes are CLAMPED, both of the blood sampling “pig tail” stopcocks are CLOSED.
  8. PRIME the circuit:  Priming the Circuit: Filling the ECMO circuit (tubing, pump, oxygenator) with crystalloid priming solution (ie Isolyte), adding 2,500 units of heparin to each 1-liter bag of priming solution.  We discuss the finer details of this with Greg Griffin, the Chief Perfusionist at the University of North Carolina, Chapel Hill in EDECMO 8.
    1. squeeze all air out of prime bag INTO the circuit and then hang those bags from the IV pole.
    2. Open the ratchet clamps: the circuit will fill (prime) by gravity.
  9. Connect the Oxygen supply line (from Oxygen tank) to the Oxygen inlet port on the oxygenator
  10. De-air the circuit:
    1. Remove the patient-lines that are hanging from the IV pole and drop them below the fluid level of the IV bags to prime them. ratchet-clamp them closed. Now the entire circuit has been primed.
    2. Open the recirculation bridge and briefly increase the RPM on the Rotaflow Console until the pump is running at 4LPM for 15 seconds. This will de-air the circuit as air is release from the de-ar exit port on the Oxygenator.  ***Some air may still be trapped in the pump though. So…
    3. Turn the RPM on the Rotaflow console to zero. Allow any air in the pump head to flow into the PVC tubing between the pump head and the oxygenator and then return the RPM to 4LPM to complete the de-airing process.
  11. Calibrate the flow-probe: Reduce pump speed to zero RPM, clamp off the recirculation bridge and “ZERO” the flow probe by pushing the “ZERO” button for a few seconds. The console will beep.

Initiation of Total Heart Lung Bypass (STAGE 3)

Maquet-Circuit-mockup.001So you've cannulated your patient while your ECMO-nurse has primed the circuit with crystalloid.  Connect the venous and arterial PVC lines from the circuit to the ECMO cannulas in the patient. And since this is STAGE 3, we've established the EDECMO “Rule of 3's.”  There are 3 things you need remember before, during, and after you've initiated heart-lung bypass.

A.  3 Critical First Steps BEFORE initiating bypass:

  1. Heparinize the patient = 5,000 units IV bolus
    1. Heparin 2,500 units in each liter of priming solution
    2. Bioline coating
    3. ACT > 200 seconds
  2. Attach O2 source (@ 4-6 LPM) to the Oxygenator
  3. No open central lines (CVP, Swan-Ganz, etc).

CLOSE the Recirculation Bridge and OPEN the venous and arterial ratchet clamps. Turn up the RPM on the Rotaflow console. Your patient is on heart-lung bypass.

B.  3 Critical things to confirm JUST AFTER your patient is on bypass:

  1. The arterial line should have bright red (oxygenated) blood and the venous line should be dark-red.
    1. IF you see BRIGHT-BRIGHT, you've incorrectly placed both cannulas in the same vessel.
    2. If you see DARK-DARK, there is a problem with the oxygenator. Confirm your O2 supply to the oxygenator.
  2. Your cannulas are secured to the skin with suture and tape.
  3. The recirculation bridge is CLOSED.

C.  3 Critical Values to Optimize ECMO

1. Optimize Blood Flow:

  • Establish the MAXIMUM blood flow (LPM) at the lowest RPM. GOAL = 60 ml/kg
  • Increase the RPM on the Rotaflow console until:
    1. Any further increases in RPM does not result in increased blood flow (LPM).
    2. The circuit begins to “Chatter.”
    3. SvO2 > 70%

IF flow is too low: 1. Infuse more volume 2. reposition venous cannula 3. add a venous cannula

2. Arterial Blood Gas Analysis:

  • GOAL:  “normal” ABG (PaO2 80-100; PaCO2 35-45)

IF PaO2 < 80,   THEN you need more blood flow through the Oxygenator

IF PaO2 > 100, THEN its time to add a gas blender and turn down the FiO2 from the Oxygen source

IF PaCO2 < 35, THEN decrease your “Sweep Gas Rate” by lowering the LPM on the O2 supply

IF PaCO2 > 45, THEN increase your “Sweep Gas Rate” by increasing the LPM on the O2 supply

 

3. Optimize Systemic Vascular Resistance (SVR)

SVR = (MAP – CVP) x 80
C.O.

SVR = (MAP – 0)      x 80
Blood Flow

***GOAL = SVR > 800

IF, for a given blood flow, the MAP is unreasonably low, you need a pure VASOPRESSOR = Phenylephrine

IF, for a given blood flow, the MAP is unreasonably HIGH, you need a VASODILATOR = Nitroprusside

Or, Goal MAP > 65

 

 The Shinar 3000: Tall Paul ECMO Simulator

Zack built an ECMO simulator model in his garage. Here is the video:

Tall Paul Compilation 3 from Joe Bellezzo on Vimeo.

The post EDECMO 20 – The Golden Hour & the Rule of 3’s: Optimizing the Critical First Hour on Heart-Lung Bypass appeared first on ED ECMO.

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In this episode, Joe talks about that first critical hour on Heart-Lung Bypass. What are the most common and critical clinical scenarios that the ECMO operator faces in that first hour on pump? Listen to this episode to find out. In this episode, Joe talks about that first critical hour on Heart-Lung Bypass. What are the most common and critical clinical scenarios that the ECMO operator faces in that first hour on pump? Listen to this episode to find out. the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 28:52 1956
ECMO Simulation Model Built by Zack!! https://edecmo.org/ecmo-simulation-model-built-by-zack/ Fri, 20 Mar 2015 18:28:11 +0000 https://edecmo.org/?p=1912 https://edecmo.org/ecmo-simulation-model-built-by-zack/#comments https://edecmo.org/ecmo-simulation-model-built-by-zack/feed/ 5 <p>Using parts purchased at Home Depot, Zack took apart a Tall Paul Anatomy Mannequin and built the whole thing from scratch. This is how it went down!</p> <p>The post <a rel="nofollow" href="https://edecmo.org/ecmo-simulation-model-built-by-zack/">ECMO Simulation Model Built by Zack!!</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p> Purchase plane tickets to Lexington, Kentucky, for Castlefest 2015?               CHECK

Make travel arrangements for SMACC 2015 in Chicago?                                    CHECK

Build a complete ECMO simulator using a Tall Paul anatomy mannequin, some PVC tubing, off-the-shelf items from Home Depot, and a cordless drill?

Well…

Using parts purchased at Home Depot, Zack took apart a Tall Paul Anatomy Mannequin and built the whole thing from scratch.  This is how it went down!

Screen Shot 2015-03-20 at 11.33.05 AM

And check out the video at 2:22: Zack powers the Maquet Rotaflow pump using an electric hand drill with magnets attached to a plastic disc.Screen Shot 2015-03-20 at 11.34.49 AM

 

The post ECMO Simulation Model Built by Zack!! appeared first on ED ECMO.

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Using parts purchased at Home Depot, Zack took apart a Tall Paul Anatomy Mannequin and built the whole thing from scratch. This is how it went down! Using parts purchased at Home Depot, Zack took apart a Tall Paul Anatomy Mannequin and built the whole thing from scratch. This is how it went down! the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 1912
EDECMO 19 – ECPR for Out-of-Hospital Cardiac Arrest Japanese-Style! https://edecmo.org/edecmo-19-ecpr-for-out-of-hospital-cardiac-arrest-japanese-style/ Thu, 19 Feb 2015 23:35:22 +0000 https://edecmo.org/?p=1873 https://edecmo.org/edecmo-19-ecpr-for-out-of-hospital-cardiac-arrest-japanese-style/#respond https://edecmo.org/edecmo-19-ecpr-for-out-of-hospital-cardiac-arrest-japanese-style/feed/ 0 <p>Tetsuya Sakamoto is the principal investigator of a multi-center prospective observational study that was just recently published in the journal Resuscitation: Resuscitation. 2014 Jun;85(6):762-8. Zack and Joe met with Dr. Sakamoto during the 2014 AHA RESS conferences and talked all things ECPR. After that, Shinar sat down with Dr. Sakamoto to get his take on how the Japanese EMS system is setup and how they are able to implement ECPR into their resuscitation protocols.</p> <p>The post <a rel="nofollow" href="https://edecmo.org/edecmo-19-ecpr-for-out-of-hospital-cardiac-arrest-japanese-style/">EDECMO 19 – ECPR for Out-of-Hospital Cardiac Arrest Japanese-Style!</a> appeared first on <a rel="nofollow" href="https://edecmo.org">ED ECMO</a>.</p> SakamotoTetsuya Sakamoto is the principal investigator of a multi-center prospective observational study comparing ECPR vs. traditional resuscitation for out of hospital cardiac arrest. His study was just recently published in the journal Resuscitation: Resuscitation. 2014 Jun;85(6):762-8. Zack and Joe met with Dr. Sakamoto during the 2014 AHA RESS conferences and talked all things ECPR.  After that, Shinar sat down with Dr. Sakamoto to get his take on how the Japanese EMS system is setup and how they are able to implement ECPR into their resuscitation protocols.

 

The Japanese Emergency Care System

  • Ambulance Crew = 1 EMT paramedic + 2 EMT's
    • EMT paramedic
      • Epi
      • Intubate
    • 2 Basic-trained EMT's
  • Hospital Systems:
    • General Hospital
    • Tertiary Hospital Receiving Centers (271 Centers)
      • Trauma
      • Resuscitation
      • Critical Care
  • Emergency Department at Japanese Tertiary Care Center
    • Emergency ICU
    • Trauma resuscitation, PCI, etc.
  • Pre-hospital protocols for Termination of Resuscitation protocols in Japan
    • In Japan, prehospitals providers are not empowered to pronounce
    • Average time on Scene = 10-20 min (scoop and run!)
    • They transport everyone!

Percutaneous Cardiopulmonary Support (ECMO) and the Save-J team

Final Thoughts

  • ECPR has huge promise for saving the lives of patients who would otherwise not survive with standard ACLS. But the cost is not trivial. So,
    1. we need to drill down into the inclusion criterion to ensure we are using this therapy on patients who will gain the most benefit.
    2. ECPR requires a team-approach, much like a trauma team activation.  The successful ECPR team still demands good-quality chest compressions, appropriate use of ACLS protocols, etc.
    3. Training is important because cannulation during arrest is tough.
  •  The Save-J approach to cannulation:   much like we do it here in the US, ultrasound-guided percutaneous approach is usually the go-to approach, with cut-down used as a rescue intervention.
*The EDECMO authors would like to thank Tetsuya Sakamoto for joining us on this episode of the EDECMO podcast and allowing us to share his thoughts on ECPR.

 

…No sex, no drugs, no wine, no women, no fun, no sin, no you, no wonder its dark…

~The Vapors (1980)

The post EDECMO 19 – ECPR for Out-of-Hospital Cardiac Arrest Japanese-Style! appeared first on ED ECMO.

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Tetsuya Sakamoto is the principal investigator of a multi-center prospective observational study that was just recently published in the journal Resuscitation: Resuscitation. 2014 Jun;85(6):762-8. Zack and Joe met with Dr. Tetsuya Sakamoto is the principal investigator of a multi-center prospective observational study that was just recently published in the journal Resuscitation: Resuscitation. 2014 Jun;85(6):762-8. Zack and Joe met with Dr. Sakamoto during the 2014 AHA RESS conferences and talked all things ECPR. After that, Shinar sat down with Dr. Sakamoto to get his take on how the Japanese EMS system is setup and how they are able to implement ECPR into their resuscitation protocols. the EDECMO Hosts - Drs. Joe Bellezzo, Zack Shinar, & Scott Weingart clean 13:23 1873