71: Should We Prioritize VV-ECMO over ECPR?

In this episode, we dive into the abyss of resource allocation.  Much of the world is saying that the limited number of ECMO circuits should be used for COVID induced lung injury.  This means that ECPR initiatives have been shut down or severely limited.  Is this the right thing to do?  What does the data say?  What strategy gives the most benefit to the most people?  Zack invited Brian Grunau to discuss these topics as well as a recent ECPR paper out of Norway and study dealing with signs of life during CPR.

 

Oslo Study

Alm-Kruse K, Sørensen G, Osbakk SA, Sunde K, Bendz B, Andersen GØ, Fiane A, Hagen OA, Kramer-Johansen J. Outcome in refractory out-of-hospital cardiac arrest before and after implementation of an ECPR protocol. Resuscitation. 2021 Feb 10;162:35-42. doi: 10.1016/j.resuscitation.2021.01.038. Epub ahead of print. PMID: 33581226.

Signs of Life Study

Debaty G, Lamhaut L, Aubert R, Nicol M, Sanchez C, Chavanon O, Bouzat P, Durand M, Vanzetto G, Hutin A, Jaeger D, Chouihed T, Labarère J. Prognostic value of signs of life throughout cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest. Resuscitation. 2021 Feb 17:S0300-9572(21)00077-0. doi: 10.1016/j.resuscitation.2021.02.022. Epub ahead of print. PMID: 33609608.

69: 2020 Synopsis

2020 was a crazy year.  This month Zack goes through the biggest ECMO lessons learned in 2020.  This is a short concise run through of ECPR, ECMO for COVID, Imaging, and Aortic Dissection.  It's a reminder of how organization is so critical to the outcome of your ECMO program.  He also reminds us how improvement in these systems of care can lead to survival rates even the believers in ECMO thought were unattainable.

 

 

66: Crash VV ECMO

Have you ever wondered how you would crash someone onto VV ECMO?  Have you ever wondered where is the best place to put the cannulas?  Have stayed up late at night wondering which patients in your department could benefit from VV rather than VA ECMO?  Then this is the episode for you!!  After a few recent cases of crash VV ECMO in our hospital, we have decided to focus on the subject.  Zack gets critical care physician and ECMO director Dr. David Willms to answer from a very practical standpoint the who, what, where of crash VVECMO.

 

online pharmacy

 

 

 

 

 

 

 

Great images from Penn – Femoral Jugular approach

Femoral Femoral Approach

 

 

 

 

 

 

 

Aortic Dissection recent paper and Editorial

https://www.resuscitationjournal.com/article/S0300-9572(20)30309-9/fulltext

https://www.resuscitationjournal.com/article/S0300-9572(20)30435-4/pdf

 

65: ECPR Journal Club: Dual Sequential Defibrillation, CT after ECMO, and much, much more

This month we tackle a number of topics.  Garrett Sterling is back again with Zack to talk about cutting edge resuscitation, ECMO, and the interplay between the two.  Dual sequential defibrillation, CT after ECMO initiation, should you perform bystander CPR in the era of Covid, some US ECMO data, and an awesome 3D modeling for ECPR training models.  All in one 30 minute podcast!
Reverse CPR – better systolic BPs
Brown J., Rogers J., Soar J. Cardiac arrest during surgery and ventilation in the prone position: a case report and systematic review. Resuscitation. 2001;50:233–238. [PubMed] [Google Scholar]
Mazer S.P., Weisfeldt M., Bai D. Reverse CPR: a pilot study of CPR in the prone position. Resuscitation. 2003;57:279–285. [PubMed] [Google Scholar] DOI:  10.1016/s0300-9572(03)00037-6
Wei J., Tung D., Sue S.H., Wu S., van Chuang Y.C., Chang C.Y. Cardiopulmonary resuscitation in prone position: A simplified method for outpatients. Journal of the Chinese Medical Association. 2006;69:202–206. [PubMed] [Google Scholar]
SLides on Prone CPR
Risk to providers of CPR in Covid
 
Fear of Covid in CPR
Witnesses still providing CPR in Covid era – 53 vs. 49% in Paris
Witnesses didn't provide in Sydney
Dual Sequential Defibrillation (DSD)
Columbus Ohio Paramedics – http://dx.doi.org/10.1016/j.resuscitation.2016.08.002
San Antonio Texas – no benefit of DSD – http://dx.doi.org/10.1016/j.resuscitation.2016.06.011
Damaged Defibrillator from DSD – DOI: 10.1016/j.annemergmed.2017.04.005
Toronto – Cheskes RCT -DSD and vector change better than standard defibrillation –  https://doi.org/10.1016/j.resuscitation.2020.02.010
National Data on ECMO use in US
J. Hadaya, et al., National trends in utilization and outcomes of extracorporeal support for in- and
out-of-hospital cardiac arrest, Resuscitation (2020), https://doi.org/10.1016/j.resuscitation.2020.02.034
Early CT after ECMO
https://doi.org/10.1016/j.resuscitation.2019.11.024
3d printed  ECPR modeling
https://doi.org/10.1016/j.resuscitation.2020.01.032

63: Covid and ECMO – Who do we cannulate? with Jenelle Badulak

“Normal life is changing.  It is now a covid 19 life” – Bin Cao

I write this with some trepidation as well as pride in the role we all get to play in Covid 19.  The sure in the US and many other places worldwide is just beginning.  It is on us to seek guidance from those who have gone through this already.  Today we will address the use of ECMO in Covid with an expert in ECMO who is in the throws of the worst outbreak of the United States – Seattle, Washington.  Jenelle Badulak and I give you a short yet powerful discussion about what Covid patients should receive ECMO.

Take homes for decision to initiate- comorbidities (HTN, DM especially), single organ dysfunction, young age, trajectory of course

Hosts – Jenelle Badulak, Zack Shinar

 

ECMO guidance for Coronavirus

  • MERS ECMO Data
    • Alshahrani MS, Sindi A, Alshamsi F, Al-Omari A, El Tahan M, Alahmadi B, Zein A, Khatani N, Al-Hameed F, Alamri S, Abdelzaher M, Alghamdi A, Alfousan F, Tash A, Tashkandi W, Alraddadi R, Lewis K, Badawee M, Arabi YM, Fan E, Alhazzani W. Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus. Ann Intensive Care. 2018 Jan 10;8(1):3. doi: 10.1186/s13613-017-0350-x. PubMed PMID: 29330690; PubMed Central PMCID: PMC5768582
  • Chinese Society of Extracorporeal Life Support. [Recommendations on extracorporeal life support for critically ill patients with novel coronavirus pneumonia]. Zhonghua Jie He He Hu Xi Za Zhi. 2020 Feb 9;43(0):E009. doi: 10.3760/cma.j.issn.1001-0939.2020.0009. [Epub ahead of print] Chinese. PubMed PMID: 32035430.
    • http://rs.yiigle.com/yufabiao/1180132.htm
    • Inclusion criteria under this paper are–>
    • Under optimal ventilation conditions (FiO 2 ≥ 0.8, tidal volume 6 ml / kg, PEEP ≥ 10 cmH 2 O), ECMO can be started if there are no contraindications and one of the following conditions is met 7 , 8 , 14 , 16 , 17 , 18 ] : (1) PaO 2 / FiO 2 <50 mmHg for more than 3 h; (2) PaO 2 / FiO 2 <80 mmHg for more than 6 h; (3) FiO 2 = 1.0, PaO 2 / FiO 2 <100 mmHg; (4) Arterial blood pH <7.25 and PaCO 2 > 60 mmHg for more than 6 hours, and respiratory rate> 35 times / min; (5) When respiratory rate> 35 times / min, blood pH <7.2 The plateau pressure was> 30 cmH 2 O; (6) severe air leak syndrome; (7) combined with cardiogenic shock or cardiac arrest.