{"id":2027,"date":"2015-06-15T08:00:26","date_gmt":"2015-06-15T12:00:26","guid":{"rendered":"https:\/\/edecmo.org\/?p=2027"},"modified":"2021-05-18T23:17:28","modified_gmt":"2021-05-19T03:17:28","slug":"edecmo-22-managing-the-crashing-tox-patient-with-ecmo-with-leon-gussow-steve-aks-from-the-poison-review","status":"publish","type":"post","link":"https:\/\/edecmo.org\/edecmo-22-managing-the-crashing-tox-patient-with-ecmo-with-leon-gussow-steve-aks-from-the-poison-review\/","title":{"rendered":"EDECMO 22 &#8211; Managing the Crashing Tox Patient with ECMO &#8211; with Leon Gussow &#038; Steve Aks from The Poison Review"},"content":{"rendered":"<!--powerpress_player--><div class=\"powerpress_player\" id=\"powerpress_player_2474\"><!--[if lt IE 9]><script>document.createElement('audio');<\/script><![endif]-->\n<audio class=\"wp-audio-shortcode\" id=\"audio-2027-1\" preload=\"none\" style=\"width: 100%;\" controls=\"controls\"><source type=\"audio\/mpeg\" src=\"http:\/\/media.blubrry.com\/edecmo\/traffic.libsyn.com\/edecmo\/edecmo-20150515-022-the-crashing-tox-patient.mp3?_=1\" \/><a href=\"http:\/\/media.blubrry.com\/edecmo\/traffic.libsyn.com\/edecmo\/edecmo-20150515-022-the-crashing-tox-patient.mp3\">http:\/\/media.blubrry.com\/edecmo\/traffic.libsyn.com\/edecmo\/edecmo-20150515-022-the-crashing-tox-patient.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-20150515-022-the-crashing-tox-patient.mp3\" class=\"powerpress_link_pinw\" target=\"_blank\" title=\"Play in new window\" onclick=\"return powerpress_pinw('https:\/\/edecmo.org\/?powerpress_pinw=2027-podcast');\" rel=\"nofollow\">Play in new window<\/a> | <a href=\"http:\/\/media.blubrry.com\/edecmo\/traffic.libsyn.com\/edecmo\/edecmo-20150515-022-the-crashing-tox-patient.mp3\" class=\"powerpress_link_d\" title=\"Download\" rel=\"nofollow\" download=\"edecmo-20150515-022-the-crashing-tox-patient.mp3\">Download<\/a> (Duration: 33:37 &#8212; 23.2MB)<\/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>&nbsp;<\/p>\n<blockquote><p>&#8230;the key thing is to put them on ECMO when they need it, but not a minute sooner!<\/p>\n<p>-Leon Gussow<\/p><\/blockquote>\n<p>In this episode Scott, Zack and Joe were all in the same room&#8230;in a conference room at the University of North Carolina, Chapel Hill &#8211; where we were doing ECPR studies in an animal model of cardiac arrest with Jim Manning. We spoke with legendary toxicologists Leon Gussow and Steve Aks about the role of ECMO and ECPR in the overdosed tox patient.<\/p>\n<p>This is a fascinating discussion about the nuances of ECMO in the crashing intoxicated patient.<\/p>\n<p>Check out <a href=\"http:\/\/Subscribe in iTunes: https:\/\/itunes.apple.com\/us\/podcast\/the-poison-review-podcast\/id798888133?mt=2\" target=\"_blank\" rel=\"noopener\">THE POISON REVIEW<\/a> and <a href=\"http:\/\/Subscribe in iTunes: https:\/\/itunes.apple.com\/us\/podcast\/the-poison-review-podcast\/id798888133?mt=2\" target=\"_blank\" rel=\"noopener\">Subscribe to them in iTunes<\/a><\/p>\n<p style=\"padding-left: 30px;\"><a href=\"https:\/\/edecmo.org\/wp-content\/uploads\/2015\/05\/Gussow.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\" wp-image-2036 size-full alignleft\" src=\"https:\/\/edecmo.org\/wp-content\/uploads\/2015\/05\/Gussow.jpg\" alt=\"Gussow\" width=\"128\" height=\"128\" srcset=\"https:\/\/edecmo.org\/wp-content\/uploads\/2015\/05\/Gussow.jpg 128w, https:\/\/edecmo.org\/wp-content\/uploads\/2015\/05\/Gussow-32x32.jpg 32w, https:\/\/edecmo.org\/wp-content\/uploads\/2015\/05\/Gussow-64x64.jpg 64w, https:\/\/edecmo.org\/wp-content\/uploads\/2015\/05\/Gussow-96x96.jpg 96w\" sizes=\"(max-width: 128px) 100vw, 128px\" \/><\/a>Leon Gussow MD,<\/p>\n<p style=\"padding-left: 60px;\">University of Illinois Medical Center, Chicago<br \/>\nJohn H. Stroger Jr. Hospital of Cook County<br \/>\nEmergency Medicine News &#8220;Toxicology Rounds&#8221;<br \/>\nMedical Editor of &#8216;The Poison Review&#8221;<\/p>\n<p style=\"padding-left: 30px;\"><a href=\"https:\/\/edecmo.org\/wp-content\/uploads\/2015\/05\/aks-1-186x2501.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\" wp-image-2038 size-full alignleft\" src=\"https:\/\/edecmo.org\/wp-content\/uploads\/2015\/05\/aks-1-186x2501.jpg\" alt=\"aks-1-186x250\" width=\"128\" height=\"172\" \/><\/a><\/p>\n<p style=\"padding-left: 30px;\">Steve Aks\u00a0DO, FACMT, FACOEP, FACEP<\/p>\n<p style=\"padding-left: 60px;\">Director, Toxicology Fellowship Program, Department of Emergency Medicine, Cook County Health and Hospitals System<\/p>\n<hr \/>\n<p>&nbsp;<\/p>\n<h3><\/h3>\n<h3><\/h3>\n<h3>Some Unique Situations:<\/h3>\n<p>ECMO and intralipid?<\/p>\n<ul>\n<li>What are the adverse effects associated with the combined use of intravenous lipid emulsion and extracorporeal membrane oxygenation in the poisoned patient.\u00a0<a title=\"Clinical toxicology (Philadelphia, Pa.).\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25634667#\">Clin Toxicol (Phila).<\/a> 2015 Mar;53(3):145-50. doi: 10.3109\/15563650.2015.1004582. Epub 2015 Jan 29.<\/li>\n<li>Bolus dose intralipid before ECMO is reasonable and should not result in significant pump complications with our current oxygenators. \u00a0However, starting intra-lipid after the patient is on bypass won&#8217;t likely provide much more benefit and could shorten the life of your oxygenator.<\/li>\n<\/ul>\n<p>ECMO and Dialysis?<\/p>\n<ul>\n<li>Hemodialysis can be done in-line with the ECMO circuit, but its preferred to use a separate dialysis catheter placed at a remote site (ie the IJ). \u00a0A dialysis circuit CAN be spliced into the ECMO circuit, but is a little more complicated. You can know more about <a href=\"http:\/\/www.thekidneydocs.com\/\">hemodialysis services<\/a> here.<\/li>\n<\/ul>\n<p>Mitochondrial and Cellular Respiration Poisons (dinitrophenol &amp; Cyanid) and Carbon Monoxide?<\/p>\n<ul>\n<li>ECMO is of NO USE in these intoxications.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>In this episode Scott, Zack and Joe were all in the same room&#8230;in a conference room at the University of North Carolina, Chapel Hill &#8211; where we were doing ECPR studies in an animal model of cardiac arrest with Jim Manning. We spoke with legendary toxicologists Leon Gussow and Steve Aks about the role of ECMO and ECPR in the overdosed tox patient.<\/p>\n","protected":false},"author":4,"featured_media":2032,"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":[1,4],"tags":[56,138,139,140],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/edecmo.org\/wp-content\/uploads\/2015\/05\/Screen-Shot-2015-05-17-at-12.04.42-PM.png","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p3JzC4-wH","_links":{"self":[{"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/posts\/2027"}],"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=2027"}],"version-history":[{"count":0,"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/posts\/2027\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/media\/2032"}],"wp:attachment":[{"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/media?parent=2027"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/categories?post=2027"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/tags?post=2027"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}