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A post arrest patient just got initiated on ECMO. Do you give fluids, add pressors, or increase flow? Marc Dickstein, an anesthesiologist from Columbia University and an expert in the physiology of ECMO, talks with Zack about how to manage these patients, what diagnostics we need and how to optimize your use of the machine. This talk is a must for everyone starting ECPR in their departments.
Marc's ECMO physiology website Harvi
Marc's ASAIO article on ECMO physiology –
Dickstein ML. The Starling Relationship and Veno-Arterial ECMO: Ventricular Distension Explained. ASAIO J. 2018 Jul/Aug;64(4):497-501. doi: 10.1097/MAT.0000000000000660. PubMed PMID: 29076945.
Zack's recent Resus Editorial on Impella
Shinar Z. Is the "Unprotected Heart" a clinical myth? Use of IABP, Impella, and ECMO in the acute cardiac patient. Resuscitation. 2019 May 21. pii: S0300-9572(19)30173-X. doi: 10.1016/j.resuscitation.2019.05.005. [Epub ahead of print] PubMed PMID: 31125528
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.