Episode 2 – The Three Stages of ECPR

In this episode, Joe and Zack discuss the three stages of ECPR initiation.

For greater detail, videos, and simulations come to the ECPR Page in the tutorial section.

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7 years ago

Ari Kestler asks about the routine use of femoral a-lines during cardiac arrest, independent from ECMO. I always place them–the reason is I dose my epi based on diastolic BP during compressions. If they get above 40 mm Hg, no repeat epi–if they don’t give another and consider some vaso. You’ll be hearing more about this here and on EMCrit. It also radically minimizes the ridiculous hunt for a pulse when you see a perfusing rhythm.

Thomas D
7 years ago

Great comments on vascular access in arrest. I do love an art-line for CPR, but mostly use it to follow compressions (with EtCO2 as the main guide). I never thought to let it guide epinephrine, but Scott’s comment makes so much sense I’m embarrassed not having thought of it! I always felt 1mg of epinephrine every three minutes was too rough a guide, and now I’ve got something better.

Joe’s take on the logistics of vascular access in arrests arriving in ED (or any super-sick patient coming in) is great! Inspiring stuff!

Thomas D
7 years ago

Thanks! Microdose epi is a life-saver (for both the doc and the patient). With the really sick patients, I tend to draw up a syring of dilluted epinephrine 10mcrg/ml and have it in my pocket as insurance. A few ml’s of that solution can usually keep a dead horse alive until you get something better going.

I\m also looking forward to your take on aortic occlusion in these settings. Both REBOA and the abdominal tourniquet has potential for keeping the circulation to the upper body where it matters in arrest.

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