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We've had some recent episodes on ECMO physiology. Today's episode focuses on the differences between ECMO physiology in the patient in cardiogenic shock versus the one in cardiac arrest. Scott Weingart talks with Zack about how the difference between these two patient populations is HUGE! Scott also mentions details about cannulation and some critical post ECMO initiation pearls.
ECPR 2.0
The Patient
1. OOH Cardiac Arrest Patients are Different
Cannulation
2. Ultrasound-Guided Percutaneous Placement
3. Wire choices
4. Wire Location Verification
5. Small arterial cannulae
6. Simpler Circuits
Post-Pump Critical Care
7. Find the Injuries
8. Mandatory leg perfusion
9. Lower Anticoagulation Goals
10. Lower Flow Goals
11. Try to avoid venting – Truby et al. PMID:28422817
12. Understanding Cardiac Prognostication / Stunning
13. Understanding Neuro Prognostication
14. Protection/Ownership
15. In it for the Long Haul
The U.S. has seen pre-hospital programs spring up in Paris, UK, and Australia. It 
was thought that due to billing issues this could never happen in America….but it has. Jon Marinaro and Darren Braude have accomplished this against all odds. Zack interviews the two of them on how they were able to accomplish this task amidst the many financial, logistic, and medical problems surrounding this monumental task.
In this episode, Sacha Richardson talks with Zack about a problem common to all ECPR programs- how do we confirm the placement of the wires? During chest compressions and even in patients with a pulse, confirmation of which vessel you have cannulated can be difficult. Sacha shares some tricks and trips on how to get real time confirmation of the wires. Sacha also gives us a preview of some of the exciting endeavors that he has undertaken in Melbourne with pre-hospital ECMO.
We've all heard of therapeutic hypothermia. Some of us have heard of deep hypothermia for traumatic arrest. But what about deep regional hypothermia of brain for cardiac arrest! Zack interviewed Rob Schultz, a CT surgeon resident from Calgary who is doing research on deep hypothermia of the brain using some of the tactics that are utilized in operating room. His stuff is mind blowing!
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.
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.
Joe is an ED Invasivist who endorses any procedure looking for an indication.
Zack is an ER doctor who enjoys a particular fondness for bringing people back from the dead. 
Scott is an ED Intensivist (whatever that means) who likes to talk to himself.