61: Jason Bartos – ECPR Redefined

Jason Bartos and his crew at the University

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of Minnesota have revolutionized the concept of ECPR for out of hospital cardiac arrests.  His crew are interventional cardiologists who take OHCA straight to the cardiac cath lab.  They have initiate times of around 6-8 minutes and have neurologically intact survival rates higher than 30%.  Below are two of Jason’s recent papers which every person who considers themselves an ECPR fan should pour over with a fine-toothed comb.  There is so much in these papers.  We split this interview into two pieces because there is so many pearls in it.

 

Outcomes

Resuscitation paper – 48% survival in 100 patients

Circulation paper 2020– 33% vs. 23% ALPS

  • Cohort who had VF/VT and one shock vs. a cohort who had VF/VT and failed to ROSC at the scene, in the ambulance, and then all the way to the hospital.
  • OHCA – > Straight to the Cath lab –> Get on ECMO –> Go to CCU under Cards care.
  • Inclusion criteria – Vf/vt, lactate <18, paO2 >50,ETCO2>10

 

References:

Bartos JA, Grunau B, Carlson C, Duval S, Ripeckyj A, Kalra R, Raveendran G,
John R, Conterato M, Frascone RJ, Trembley A, Aufderheide TP, Yannopoulos D.
Improved Survival with Extracorporeal Cardiopulmonary Resuscitation Despite
Progressive Metabolic Derangement Associated with Prolonged Resuscitation.
Circulation. 2020 Jan 3. doi: 10.1161/CIRCULATIONAHA.119.042173. [Epub ahead of
print] PubMed PMID: 31896278.

Bartos JA, Carlson K, Carlson C, Raveendran G, John R, Aufderheide TP,
Yannopoulos D. Surviving refractory out-of-hospital ventricular fibrillation
cardiac arrest: Critical care and extracorporeal membrane oxygenation management.
Resuscitation. 2018 Nov;132:47-55. doi: 10.1016/j.resuscitation.2018.08.030. Epub
2018 Aug 29. PubMed PMID: 30171974.

EDECMO 36 – Crushing the Nihilism of Cardiac Arrest – with Demetris Yannopoulos

…all acute injury to the heart is reversible.

 

Demetris Yannapoulos
University of Minnesota

In this podcast episode, Zack interviews Demetris Yannopoulos from the University of Minnesota. Demetris has organized Minneapolis into arguably the most impressive ECPR city in the world. He has changed the mindset of out of hospital refractory ventricular fibrillation care from “stay and play”, the philosophy that medics should stay at the scene and provide care until ROSC (return of spontaneous circulation) or until the patient is pronounced dead. In Minneapolis, a patient who who arrests in  Yannopoulos’ catchment area gets three shocks. If the patient does not get ROSC then they are immediately transported to the University of Minnesota using LUCAS mechanical chest compression device. The patient bypasses the emergency department and goes directly to the cath lab. In the cath lab, Demetris, or one of his partners, cannulates and initiates ECMO with an average time of 6 minutes!!! In his first 90 patients he has had a 45% neurologically intact survivorship. Patients are getting to the cath lab on average 60 minutes after their arrest. In this cohort, you would expect a less than 1% survival. We can use Dr. Yannopoulos’ model to expand the use of ECPR in many other systems. The real question is do we have champions like Demetris who will rise to the calling!