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This month Zack gives a few pearls from the recent Reanimate courses and annual ELSO meeting in Boston before he interviews Gowry Mork from Aarhus University about her fantastic recent paper.
- Pearl #1 is about hand placement in cannulation. Hold the ultrasound in your left an
d needle in right. Once in the vessel, drop the US probe and take your left hand and gently hold the needle. With your right hand grab the wire far enough up to be to insert into the vessel in one push. - Gowry’s paper has many interesting points. Probably the biggest is the reasonable survivorship for prolonger arrests. This is tied to equality of care for patient who live far from the closest ECMO center.
Gowry’s paper –
Mørk SR, Bøtker MT, Christensen S, Tang M, Terkelsen CJ. Survival and neurological outcome after out-of-hospital cardiac arrest treated with and without mechanical circulatory support. Resusc Plus. 2022 Apr 6;10:100230. doi: 10.1016/j.resplu.2022.100230. PMID: 35434669; PMCID: PMC9010695.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9010695/
Gowry’s Twitter
@MSivagowry – https://mobile.twitter.com/msivagowry
This month we are honored to have Neville Vlok on the show. Neville has been one of the key physicians pushing for ECPR in South Africa. In this episode, we explore what medicine and resuscitation looks like in South Africa, how ECMO has been utilized, and whether ECMO even makes sense in developing countries.
Wait…ECPR works?
#tbs19 The Big Sick—- You’ve heard of ECMO for cardiac arrest- utilizing a mechanical pump to aid in perfusion of the coronaries. What if you can’t do ECMO? What if your resources are such that simply can’t lug a 10 kilogram machine out into the field? Well, Jostein Brede may have something for you to consider. He and several other places worldwide are on the forefront of using a REBOA catheter to occlude the proximal aorta during chest compressions in hopes that coronary perfusion pressure increases. This would subsequently improve chance of return of spontaneous circulation and overall survivorship. Maybe this is the band-aid that can be used in austere environments like rural Norway where the temperatures are extreme, the people are sparse, but the physicians are motivated. 
