80: The Expert Approved ECPR Procedure with Florian Schmitzberger

In this episode,  Zack interviews Florian Schmitzberger who just published a fantastic study that incorporates fourteen leaders within the ECPR community to hash out the specific procedural steps associated with ECPR.

 

INCLUSION
• Age <75 years
• Witnessed arrest
• Initial rhythm is shockable rhythm (VF / VT)
• ECPR can be initiated within 60 minutes of the arrest, though a longer interval may be considered circumstantially (e.g. hypothermic arrest)
• Aggressive ICU care consistent with patient wishes
• No prolonged downtime without CPR
• End-tidal CO2 ≥ 10 mmHg (unless pulmonary embolism is suspected)
• Treating physician/surgeon agreement to proceed
EXCLUSION
• Contraindication to anticoagulation
• Cannot perform activities of daily living at baseline
• Advanced comorbidities / known irreversible organ failure
• Advanced COPD or other pulmonary comorbidities
• Metastatic malignancy
• Major stroke or neurologic impairment
• Do-not-resuscitate / Do-not-intubate status

 

The Paper

Schmitzberger FF, Haas NL, Coute RA, Bartos J, Hackmann A, Haft JW, Hsu CH, Hutin A, Lamhaut L, Marinaro J, Nagao K, Nakashima T, Neumar R, Pellegrino V, Shinar Z, Whitmore SP, Yannopoulos D, Peterson WJ. ECPR2: Expert Consensus on PeRcutaneous Cannulation for Extracorporeal CardioPulmonary Resuscitation. Resuscitation. 2022 Oct;179:214-220. doi: 10.1016/j.resuscitation.2022.07.003. Epub 2022 Jul 8. PMID: 35817270.

75: Pulmonary Embolism and ECPR

In this short episode, Zack makes two points.  One, it was tough to get to where we are with ECMO acceptance.  Two, cardiac arrest patients in PEA should be considered for ECPR.  Below is the full editorial Zack and Alice did recently in the Journal of Resuscitation on the topic.  It was born out of a fantastic German article centered looking at registry outcomes for PE and ECMO.

 

Full Free Link to Editorial (until January 2022) – https://authors.elsevier.com/a/1eAXK_6ryqqpRd

Article link – https://www.resuscitationjournal.com/article/S0300-9572(21)00403-2/fulltext

 

 

Get the Textbook from ELSO – ebook click here

Hardcover here

EDECMO 43: The Cutdown

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