{"id":1540,"date":"2014-10-14T23:50:16","date_gmt":"2014-10-15T03:50:16","guid":{"rendered":"https:\/\/edecmo.org\/?p=1540"},"modified":"2021-11-02T19:12:32","modified_gmt":"2021-11-02T23:12:32","slug":"edecmo-15-cheer-trial-part-2-interview-dr-stephen-bernard","status":"publish","type":"post","link":"https:\/\/edecmo.org\/edecmo-15-cheer-trial-part-2-interview-dr-stephen-bernard\/","title":{"rendered":"EDECMO 15: The CHEER Trial &#038; Part 2 of our Interview with Dr. Stephen Bernard"},"content":{"rendered":"<!--powerpress_player--><div class=\"powerpress_player\" id=\"powerpress_player_6778\"><!--[if lt IE 9]><script>document.createElement('audio');<\/script><![endif]-->\n<audio class=\"wp-audio-shortcode\" id=\"audio-1540-1\" preload=\"none\" style=\"width: 100%;\" controls=\"controls\"><source type=\"audio\/mpeg\" src=\"http:\/\/media.blubrry.com\/edecmo\/traffic.libsyn.com\/edecmo\/edecmo-20141013-015-cheer-Bernard.mp3?_=1\" \/><a href=\"http:\/\/media.blubrry.com\/edecmo\/traffic.libsyn.com\/edecmo\/edecmo-20141013-015-cheer-Bernard.mp3\">http:\/\/media.blubrry.com\/edecmo\/traffic.libsyn.com\/edecmo\/edecmo-20141013-015-cheer-Bernard.mp3<\/a><\/audio><\/div><p class=\"powerpress_links powerpress_links_mp3\" style=\"margin-bottom: 1px !important;\">Podcast: <a href=\"http:\/\/media.blubrry.com\/edecmo\/traffic.libsyn.com\/edecmo\/edecmo-20141013-015-cheer-Bernard.mp3\" class=\"powerpress_link_pinw\" target=\"_blank\" title=\"Play in new window\" onclick=\"return powerpress_pinw('https:\/\/edecmo.org\/?powerpress_pinw=1540-podcast');\" rel=\"nofollow\">Play in new window<\/a> | <a href=\"http:\/\/media.blubrry.com\/edecmo\/traffic.libsyn.com\/edecmo\/edecmo-20141013-015-cheer-Bernard.mp3\" class=\"powerpress_link_d\" title=\"Download\" rel=\"nofollow\" download=\"edecmo-20141013-015-cheer-Bernard.mp3\">Download<\/a> (Duration: 31:42 &#8212; 21.9MB)<\/p><p class=\"powerpress_links powerpress_subscribe_links\">Subscribe: <a href=\"https:\/\/edecmo.org\/feed\/podcast\/\" class=\"powerpress_link_subscribe powerpress_link_subscribe_rss\" target=\"_blank\" title=\"Subscribe via RSS\" rel=\"nofollow\">RSS<\/a><\/p><p>In this episode Zack and Joe discuss the CHEER Trial (mechanical <strong>C<\/strong>PR, <strong>H<\/strong>ypothermia, <strong>E<\/strong>CMO, and <strong>E<\/strong>arly <strong>R<\/strong>evascularization) and follow up with Dr. Stephen Bernard\u00a0with\u00a0a few more questions about ECMO at the Alfred. Just days\u00a0after we published our initial <a title=\"EDECMO Episode #14: ECPR with Stephen Bernard 1\/2\" href=\"https:\/\/edecmo.org\/edecmo-episode-14-ecpr-stephen-bernard\/\">interview With Dr. Stephen Bernard<\/a> from the <a href=\"http:\/\/www.alfred.org.au\/\">Alfred Hospital<\/a> in Melbourne, Australia, the <a href=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/CHEER.pdf\">CHEER<\/a>\u00a0Trial\u00a0was published.<\/p>\n<p><strong>Background: <\/strong>\u00a0\u00a0Recently, we\u00a0reviewed two big papers in the ECPR (Extracorporeal Cardiopulmonary Resuscitation) World: 1.) <a href=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/08\/CPS-Chen-Lancet-Study.pdf\">The Chen Trial<\/a>\u00a0(Lancet 2008):\u00a0a large prospective observational study of<em> in-house<\/em> arreest (IHCA), out of Taiwan, that showed 32.6% (ECPR) benefit vs. 17% (non-ECPR); and 2.) The <a href=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/08\/SAVE-J.pdf\"><em>Save-J<\/em> Trial<\/a> (Resuscitation 2014): a large prospective observational study of <em>Out-of-Hospital<\/em> cardiac arrest (OHCA) that showed a 11.2% (ECPR) benefit vs. 2.6% (non-ECPR). Indeed these numbers are impressive! We all know that we need a randomized, controlled trial (RCT) but until then the guys at the Alfred Hospital in Melbourne, Australia decided to up the ante and published the initial findings of this pilot study. That study was called CHEER. \u00a0This amounts to a hyper-aggressive, bundled protocol that begins on the street (EMS) and ends in the cath lab, whereafter world-class critical care has resulted in some remarkable initial numbers.<\/p>\n<p>&nbsp;<\/p>\n<h3><a href=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/CHEER.pdf\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-1561 size-thumbnail\" src=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/Screen-Shot-2014-10-13-at-11.10.27-AM-150x150.png\" alt=\"Screen Shot 2014-10-13 at 11.10.27 AM\" width=\"150\" height=\"150\" srcset=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/Screen-Shot-2014-10-13-at-11.10.27-AM-150x150.png 150w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/Screen-Shot-2014-10-13-at-11.10.27-AM-144x144.png 144w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/Screen-Shot-2014-10-13-at-11.10.27-AM-32x32.png 32w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/Screen-Shot-2014-10-13-at-11.10.27-AM-64x64.png 64w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/Screen-Shot-2014-10-13-at-11.10.27-AM-96x96.png 96w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/Screen-Shot-2014-10-13-at-11.10.27-AM-128x128.png 128w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/a>CHEER (mechanical CPR, Hypothermia, ECMO, &amp; Early Revascularization)<\/h3>\n<p>This is a single-center, prospective, pilot study that was done over 32 months. \u00a0The primary outcome measure was short and long-term outcomes at CPC 1 or 2 (excellent neurologic outcome). The guys down-under generated inclusion criteria to capture the most salvageable patients who suffered out-of-hospital cardiac arrest (OHCA), combined those with in-hospital cardiac arrest (IHCA) patients and applied the CHEER algorithm:<\/p>\n<ul>\n<li><strong>C<\/strong>PR (using the Zoll Autopulse)<\/li>\n<li><strong>H<\/strong>ypothermia (initiated intra-arrest with iced saline)<\/li>\n<li><strong>E<\/strong>CMO (cannulation in the ED by intensivists)<\/li>\n<li><strong>E<\/strong>arly <strong>R<\/strong>evascularization (aka a trip to the cath lab)<\/li>\n<\/ul>\n<figure id=\"attachment_1569\" aria-describedby=\"caption-attachment-1569\" style=\"width: 150px\" class=\"wp-caption alignright\"><a href=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/Autopulse.jpeg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-1569 size-thumbnail\" src=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/Autopulse-150x150.jpeg\" alt=\"Autopulse\" width=\"150\" height=\"150\" srcset=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/Autopulse-150x150.jpeg 150w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/Autopulse-144x144.jpeg 144w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/Autopulse-32x32.jpeg 32w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/Autopulse-64x64.jpeg 64w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/Autopulse-96x96.jpeg 96w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/Autopulse-128x128.jpeg 128w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/a><figcaption id=\"caption-attachment-1569\" class=\"wp-caption-text\">Zoll Autopulse (TM)<\/figcaption><\/figure>\n<p>And all this was begun in the prehospital setting. Since the EMS system in their neighborhood is a single-provider system, they were able to get support from <a href=\"http:\/\/www.zoll.com\/\" target=\"_blank\" rel=\"noopener\">Zoll Pharmaceuticals<\/a> to supply all of their rigs with their mechanical chest compression device &#8211; the <a href=\"http:\/\/www.zoll.com\/medical-products\/cardiac-support-pump\/autopulse\/\" target=\"_blank\" rel=\"noopener\">Zoll Autopulse<\/a>. Patients who met inclusion criteria were met by EMS, put on the Autopulse, and transported to the Alfred. EMS also began intra-arrest cooling by rapid infusion of iced saline at 30cc\/kg. On arrival to their Emergency Department, intensivists met the patient and began the cannulation process. Once on ECMO the patients were immediately brought to the cath lab for revascularization. IHCA patients received the identical protocol, obviously minus the limo ride to the hospital.<\/p>\n<p>In 2014 this amounts to a super-aggressive bundle therapy that just makes us salivate over here in the US. \u00a0Initiating intra-arrest cooling and mechanical chest compressions in the pre-hospital setting is formidable goal for us.<\/p>\n<p><strong>Their results:<\/strong> 26 patients were entered into the protocol (11 with OHCA, 15 with IHCA). The median age was 52 years. ECMO was established in 24 (2 patients in the OHCA arm were pushed through the protocol but didn&#8217;t actually go on pump; one was cannulated but achieved ROSC prior to going to cath lab and therefore was not put on bypass, and the other patient had a failed cannulation attempt but was taken to the cath lab anyway (presumably on Autopulse) and survived. Both OHCA patients and IHCA arrest patients were grouped together in their outcome data. ROSC (return of spontaneous circulation) was achieved in 25 (96%) patients. 13\/24 (54%) were able to be weaned from ECMO support and survival to hospital discharge with full neurological recovery (CPC score 1) occurred in 14\/26 (54%). \u00a0These are remarkable initial results that higher than what we&#8217;ve seen in larger studies.<\/p>\n<p><strong>Talking points:<\/strong><\/p>\n<ul>\n<li><em>Why such good outcomes?<\/em> The patient-oriented outcomes in this pilot study are remarkable. Why are their numbers so much higher than much larger studies we&#8217;ve seen in the past? Was it the small sample size? Was it because they grouped the OHCA and IHCA arrest patients into their outcome measures (with IHCA outcomes historically known to be much better)? Was it the bundle?<\/li>\n<li><em>Which therapy really made the difference?<\/em> Was this the result of aggressive pre-hospital cooling? Was it the result of a &#8220;load-and-go&#8221; EMS policy with proper use of the mechanical chest compression device? Was it rapid deployment of ECPR? Likely, its all of these. Like much in the resuscitation world, its likely the bundle (the CHEER) followed by excellent critical care at their ECMO facility. But we can&#8217;t say for sure.<\/li>\n<li><em>Mechanical chest compression devices (ie the Zoll Autopulse or the LUCAS2 by Physio-Control).<\/em> 3 studies so far have basically shown no benefit of these devices over good quality human CPR. But most resuscitationists who have used these devices believe in their utility. I believe in their utility. Many of the reasons are less tangible than the patient-oriented outcomes measured in those papers. One of those intangibles is highlighted in this study: patients can be safely and rapidly transported to the ED with excellent ongoing chest compressions, and rescue personal can be safely strapped into their harnesses during transport.<\/li>\n<li><em>ECMO.<\/em>\n<figure id=\"attachment_1572\" aria-describedby=\"caption-attachment-1572\" style=\"width: 150px\" class=\"wp-caption alignright\"><a href=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/stratos.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-1572 size-thumbnail\" src=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/stratos-150x150.jpg\" alt=\"stratos\" width=\"150\" height=\"150\" srcset=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/stratos-150x150.jpg 150w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/stratos-144x144.jpg 144w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/stratos-32x32.jpg 32w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/stratos-64x64.jpg 64w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/stratos-96x96.jpg 96w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/stratos-128x128.jpg 128w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/a><figcaption id=\"caption-attachment-1572\" class=\"wp-caption-text\">Red Bull Stratos<\/figcaption><\/figure>\n<p>Study after study has shown that the single biggest key to the success of ECPR is the time to initiation of bypass. So in this trial, the rapid transport with Autopulse and rapid activation of the ECMO team optimized this interval. \u00a0But we believe the success of this study would not have been possible without ECMO as the final bridge\u00a0that could make all this happen. \u00a0To highlight this concept, on October 14, 2012\u00a0Austrian\u00a0skydiver\u00a0<a href=\"http:\/\/en.wikipedia.org\/wiki\/Felix_Baumgartner\" target=\"_blank\" rel=\"noopener\">Felix Baumgartner<\/a>\u00a0jumped\u00a0from the <a href=\"http:\/\/en.wikipedia.org\/wiki\/Red_Bull_Stratos\">Red Bull Stratos<\/a>\u00a0capsule 24 miles above New Mexico, USA and broke \u00a03 World Records: a.) Exit Altitude (24.2145 miles) b.) Maximum Vertical Speed (843.6 mph) and c.) Vertical Distance of Freefall (119,431 ft). And he broke the sound barrier.<\/p>\n<figure id=\"attachment_1576\" aria-describedby=\"caption-attachment-1576\" style=\"width: 150px\" class=\"wp-caption alignright\"><a href=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/felix-baumgartner-landing.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-thumbnail wp-image-1576\" src=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/felix-baumgartner-landing-150x150.jpg\" alt=\"Baumgartner parachute\" width=\"150\" height=\"150\" srcset=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/felix-baumgartner-landing-150x150.jpg 150w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/felix-baumgartner-landing-144x144.jpg 144w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/felix-baumgartner-landing-32x32.jpg 32w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/felix-baumgartner-landing-64x64.jpg 64w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/felix-baumgartner-landing-96x96.jpg 96w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/felix-baumgartner-landing-128x128.jpg 128w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/a><figcaption id=\"caption-attachment-1576\" class=\"wp-caption-text\">Baumgartner parachute<\/figcaption><\/figure>\n<p>Advancements in technology, human transport, a willingness to push the envelope, and huge set of balls, made that happen. But that couldn&#8217;t have been done without a relatively simple device that has been around for decades that allowed Baumgartner to land on his feet: the parachute &#8211; a device that &#8220;bridges&#8221; the skydiver from potential free fall-death to soft landing with\u00a0proper deployment. \u00a0ECMO can be thought of as one such device.<\/li>\n<li>\n<blockquote style=\"margin: 0 0 0 40px; border: none; padding: 0px;\"><p>Update 10\/25\/2014 Hot off the press: Google Senior Vice-President Alan Eustace one-upped Baumgartner on October 24th when he jumped 135,890 ft from a helium balloon to become the World-record holder for highest parachute jump. Additionally, Eustace used no corporate funding and did not use a capsule, opting instead to be carried into the stratosphere in a space suit alone. Here are some photos of that:<\/p><\/blockquote>\n<ul>\n<li>\n<figure id=\"attachment_1614\" aria-describedby=\"caption-attachment-1614\" style=\"width: 740px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/Screen-Shot-2014-10-25-at-11.39.21-AM.png\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-1614 size-medium\" src=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/Screen-Shot-2014-10-25-at-11.39.21-AM-740x351.png\" alt=\"Alan Eustace, a senior vice president at Google, broke the world record for high-altitude jumps. \" width=\"740\" height=\"351\" srcset=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/Screen-Shot-2014-10-25-at-11.39.21-AM-740x351.png 740w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/Screen-Shot-2014-10-25-at-11.39.21-AM-1024x486.png 1024w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/Screen-Shot-2014-10-25-at-11.39.21-AM-900x427.png 900w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/Screen-Shot-2014-10-25-at-11.39.21-AM.png 1030w\" sizes=\"(max-width: 740px) 100vw, 740px\" \/><\/a><figcaption id=\"caption-attachment-1614\" class=\"wp-caption-text\">Alan Eustace, a senior vice president at Google, broke the world record for high-altitude jumps.<\/figcaption><\/figure>\n<figure id=\"attachment_1615\" aria-describedby=\"caption-attachment-1615\" style=\"width: 600px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/JUMP-articleLarge.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-1615 size-full\" src=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/JUMP-articleLarge.jpg\" alt=\"Alan Eustace ascending to 135,890 feet on Friday. He later plummeted to earth at speeds reaching 822 miles per hour, setting off a small sonic boom heard by people on the ground.\" width=\"600\" height=\"399\" \/><\/a><figcaption id=\"caption-attachment-1615\" class=\"wp-caption-text\">Alan Eustace ascending to 135,890 feet on Friday. He later plummeted to earth at speeds reaching 822 miles per hour, setting off a small sonic boom heard by people on the ground.<\/figcaption><\/figure>\n<figure id=\"attachment_1616\" aria-describedby=\"caption-attachment-1616\" style=\"width: 180px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/Eustace.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-1616 size-full\" src=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/Eustace.jpg\" alt=\"Alan Eustace, Senior Vice President of Google\" width=\"180\" height=\"254\" \/><\/a><figcaption id=\"caption-attachment-1616\" class=\"wp-caption-text\">Alan Eustace, Senior Vice President of Google<\/figcaption><\/figure>\n<figure id=\"attachment_1617\" aria-describedby=\"caption-attachment-1617\" style=\"width: 600px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/Eustace-Landing.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-1617 size-full\" src=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/Eustace-Landing.jpg\" alt=\"Mr. Eustace landing. He wore a specially designed spacesuit with a life-support system.\" width=\"600\" height=\"401\" \/><\/a><figcaption id=\"caption-attachment-1617\" class=\"wp-caption-text\">Mr. Eustace landing. He wore a specially designed spacesuit with a life-support system.<\/figcaption><\/figure>\n<hr \/>\n<h4>MORE!<\/h4>\n<ol>\n<li>Check out <a href=\"https:\/\/edecmo.org\/edecmo-episode-14-ecpr-stephen-bernard\/\" target=\"_blank\" rel=\"noopener\">Part 1 of our interview with Dr. Bernard<\/a><\/li>\n<li>Check out <a href=\"http:\/\/intensiveblog.com\/\" target=\"_blank\" rel=\"noopener\">INTENSIVE<\/a>, The Alfred&#8217;s educational website and blog<\/li>\n<\/ol>\n<hr \/>\n<h4>Announcements:<\/h4>\n<p>1. Sign Up for the Mailing List<\/p>\n<p>Subscribe to our Mailing List:\u00a0<input id=\"mce-EMAIL\" name=\"EMAIL\" type=\"email\" value=\"\" \/>\u00a0(EDECMO will NEVER Spam)<\/p>\n<p>2. iTunes Reviews: Is the EDECMO podcast helpful to you? Please leave us a review on <a title=\"The EDECMO iTunes page\" href=\"https:\/\/itunes.apple.com\/us\/podcast\/ed-ecmo\/id675769252?mt=2&amp;ign-mpt=uo%3D4\" target=\"_blank\" rel=\"noopener\">EDECMO page in iTunes<\/a><\/p>\n<p>3. EDECMO Voicemail: 1-<strong>470 &#8211; ED ECMO 1\u00a0<\/strong>(leave us a voicemail comment or question and we may use it as part of the show!)<\/p>\n<p>4. Upcoming Events:<\/p>\n<ul>\n<li>&#8220;Bring Me Back to Life!&#8221; October 21, 2014 (That&#8217;s next week!). This is an All-Star Lineup of Resuscitationists:<\/li>\n<\/ul>\n<blockquote class=\"twitter-tweet\" lang=\"en\"><p>&#8220;Bring Me Back to Life!&#8221; (BMBTL) Montreal next week (Oct 21): <a href=\"http:\/\/t.co\/1llmhKPhLl\">http:\/\/t.co\/1llmhKPhLl<\/a>. All-Star Resusc Lineup <a href=\"http:\/\/t.co\/7lFEmDMxa1\">pic.twitter.com\/7lFEmDMxa1<\/a><\/p>\n<p>\u2014 ED ECMO Project (@edecmo) <a href=\"https:\/\/twitter.com\/edecmo\/status\/521712459691094016\">October 13, 2014<\/a><\/p><\/blockquote>\n<p><script src=\"\/\/platform.twitter.com\/widgets.js\" async=\"\" type=\"mce-no\/type\" charset=\"utf-8\"><\/script><\/p>\n<ul>\n<li><a href=\"http:\/\/www.essentialsofem.com\/course\/2014\" target=\"_blank\" rel=\"noopener\">Essentials of Emergency Medicine:<\/a> Nov 6-10, 2014<\/li>\n<\/ul>\n<p><a href=\"http:\/\/www.essentialsofem.com\/course\/2014\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-1554\" src=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/Screen-Shot-2014-10-13-at-10.59.43-AM-150x150.png\" alt=\"Screen Shot 2014-10-13 at 10.59.43 AM\" width=\"150\" height=\"150\" srcset=\"https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/Screen-Shot-2014-10-13-at-10.59.43-AM-150x150.png 150w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/Screen-Shot-2014-10-13-at-10.59.43-AM-144x144.png 144w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/Screen-Shot-2014-10-13-at-10.59.43-AM-32x32.png 32w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/Screen-Shot-2014-10-13-at-10.59.43-AM-64x64.png 64w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/Screen-Shot-2014-10-13-at-10.59.43-AM-96x96.png 96w, https:\/\/edecmo.org\/wp-content\/uploads\/2014\/10\/Screen-Shot-2014-10-13-at-10.59.43-AM-128x128.png 128w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/a><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<hr \/>\n<h4><\/h4>\n","protected":false},"excerpt":{"rendered":"<p>In this episode Zack and Joe discuss the CHEER Trial (mechanical CPR, Hypothermia, ECMO, and Early Revascularization) and follow up with Dr. Stephen Bernard with a few more questions about ECMO at the Alfred.<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false}}},"categories":[4],"tags":[104,103,56,99,105],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p3JzC4-oQ","_links":{"self":[{"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/posts\/1540"}],"collection":[{"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/comments?post=1540"}],"version-history":[{"count":1,"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/posts\/1540\/revisions"}],"predecessor-version":[{"id":6830,"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/posts\/1540\/revisions\/6830"}],"wp:attachment":[{"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/media?parent=1540"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/categories?post=1540"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/tags?post=1540"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}