{"id":3711,"date":"2017-12-29T22:04:15","date_gmt":"2017-12-30T02:04:15","guid":{"rendered":"https:\/\/edecmo.org\/?p=3711"},"modified":"2017-12-29T22:04:15","modified_gmt":"2017-12-30T02:04:15","slug":"edecmo-41-3-stages-ecpr-dianes-story-2","status":"publish","type":"post","link":"https:\/\/edecmo.org\/edecmo-41-3-stages-ecpr-dianes-story-2\/","title":{"rendered":"EDECMO 41 &#8211; The 3 Stages of ECPR &#8211; Diane&#8217;s Story"},"content":{"rendered":"<!--powerpress_player--><div class=\"powerpress_player\" id=\"powerpress_player_7879\"><!--[if lt IE 9]><script>document.createElement('audio');<\/script><![endif]-->\n<audio class=\"wp-audio-shortcode\" id=\"audio-3711-1\" preload=\"none\" style=\"width: 100%;\" controls=\"controls\"><source type=\"audio\/mpeg\" src=\"http:\/\/media.blubrry.com\/edecmo\/traffic.libsyn.com\/edecmo\/EDECMO-20171210-ecmo-3-stages_3.mp3?_=1\" \/><a href=\"http:\/\/media.blubrry.com\/edecmo\/traffic.libsyn.com\/edecmo\/EDECMO-20171210-ecmo-3-stages_3.mp3\">http:\/\/media.blubrry.com\/edecmo\/traffic.libsyn.com\/edecmo\/EDECMO-20171210-ecmo-3-stages_3.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-20171210-ecmo-3-stages_3.mp3\" class=\"powerpress_link_pinw\" target=\"_blank\" title=\"Play in new window\" onclick=\"return powerpress_pinw('https:\/\/edecmo.org\/?powerpress_pinw=3711-podcast');\" rel=\"nofollow\">Play in new window<\/a> | <a href=\"http:\/\/media.blubrry.com\/edecmo\/traffic.libsyn.com\/edecmo\/EDECMO-20171210-ecmo-3-stages_3.mp3\" class=\"powerpress_link_d\" title=\"Download\" rel=\"nofollow\" download=\"EDECMO-20171210-ecmo-3-stages_3.mp3\">Download<\/a> (Duration: 30:32 &#8212; 42.2MB)<\/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>[The original EDECMO 41 post had to be taken down&#8230;for reasons beyond our control! But here is the new and improved Episode 41]<\/p>\n<p>In this episode Zack and Joe discuss the 3-stages of Extracorporeal Membrane Oxygenation (ECMO) &#8211; or put another way, this is how to start Extracorporeal Cardiopulmonary Resuscitation (ECPR) in the Emergency Department (ED). It&#8217;s been 4 years since we talked about these basic premises of ECPR. But this time, its highlighted in a very special story.<\/p>\n<p><strong>The Three Stages of ECPR:<\/strong><\/p>\n<ol>\n<li>Placement of any commercially available catheters into the femoral artery and femoral vein.\n<ul>\n<li>Ultrasound-guided percutaneous access is our preference, but cutdown is also considered. \u00a0This is done in every patient, every time, and is done in parallel to ongoing ACLS. Transduce the arterial line to guide resuscitation and use the venous line for resuscitation purposes.<\/li>\n<\/ul>\n<\/li>\n<li>Transition to ECMO cannulas\n<ul>\n<li>Using guidewires (we prefer the Amplatz Super Stiff 145 cm .038&#8243; teflon coated floppy tip wires), remove the catheters placed in Stage 1, perform serial dilation, and place ECMO cannulas<\/li>\n<\/ul>\n<\/li>\n<li>Initiate the ECMO pump\n<ul>\n<li>Perform &#8216;underwater seal&#8217; using crystalloid, which closes the circuit. \u00a0The circuit is de-aired and the pump is started. \u00a0Increase the RPM to 1500 and remove the clamps. \u00a0Inspect the circuit and troubleshoot any issues.<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<p><em>3 stages. 3 steps.<\/em><\/p>\n<p>You can find a whole lot more on our <a href=\"https:\/\/edecmo.org\/logistics\/ecpr\/\">ECPR 3 stages page<\/a>.<\/p>\n<p>EVEN BETTER! If you are interested in learning all about ED ECMO, with hands-on simulators, Wold-renowned ECMO educators, REBOA, ECPR, computer simulation, check out the <a href=\"http:\/\/reanimateconference.com\/\">REANIMATE conference<\/a> site or go directly to the <a href=\"http:\/\/r5docs.eventzilla.net\/web\/event?eventid=2138928017\">REANIMATE registration page<\/a>!!<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Diane&#8217;s Story:<\/strong><\/p>\n<p>November 30, 2017: Diane suffered ventricular fibrillation (VF) cardiac arrest and collapsed&#8230;just outside the ED doors. \u00a0CPR was started immediately by an ED nurse. After 32 minutes of failed Advanced Cardiac Life Support (ACLS), with human and mechanical chest compressions, she remained in refractory VF.<\/p>\n<p>Our Emergency Physician-initiated ECMO (ED-ECMO) protocol was initiated using the &#8216;3 stages of ECMO.&#8217; \u00a0 Diane was &#8216;on pump&#8217; in 32 minutes, taken to the cath lab, and had her 95% LAD lesion stented by Interventional Cardiologist Arvin Narula.<\/p>\n<p>Diane went home with her family and friends on December 13, 2017. \u00a0Listen to the episode to hear the details&#8230;<\/p>\n<figure id=\"attachment_3710\" aria-describedby=\"caption-attachment-3710\" style=\"width: 740px\" class=\"wp-caption alignleft\"><a href=\"https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0011.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-3710\" src=\"https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0011-740x555.jpg\" alt=\"\" width=\"740\" height=\"555\" srcset=\"https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0011-740x555.jpg 740w, https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0011-768x576.jpg 768w, https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0011-1024x768.jpg 1024w, https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0011.jpg 2048w\" sizes=\"(max-width: 740px) 100vw, 740px\" \/><\/a><figcaption id=\"caption-attachment-3710\" class=\"wp-caption-text\">Diane&#8217;s Widowmaker<\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<figure id=\"attachment_3679\" aria-describedby=\"caption-attachment-3679\" style=\"width: 740px\" class=\"wp-caption alignleft\"><a href=\"https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0054.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-3679\" src=\"https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0054-740x416.jpg\" alt=\"\" width=\"740\" height=\"416\" srcset=\"https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0054-740x416.jpg 740w, https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0054-768x432.jpg 768w, https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0054-1024x576.jpg 1024w, https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0054.jpg 2048w\" sizes=\"(max-width: 740px) 100vw, 740px\" \/><\/a><figcaption id=\"caption-attachment-3679\" class=\"wp-caption-text\">Dr. Narula, Interventional Cardiology<\/figcaption><\/figure>\n<p><a href=\"https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0055.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-medium wp-image-3709\" src=\"https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0055-740x416.jpg\" alt=\"\" width=\"740\" height=\"416\" srcset=\"https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0055-740x416.jpg 740w, https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0055-768x432.jpg 768w, https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0055-1024x576.jpg 1024w, https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0055.jpg 2048w\" sizes=\"(max-width: 740px) 100vw, 740px\" \/><\/a><\/p>\n<figure id=\"attachment_3708\" aria-describedby=\"caption-attachment-3708\" style=\"width: 740px\" class=\"wp-caption alignleft\"><a href=\"https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0078-1.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-3708\" src=\"https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0078-1-740x416.jpg\" alt=\"\" width=\"740\" height=\"416\" srcset=\"https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0078-1-740x416.jpg 740w, https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0078-1-768x432.jpg 768w, https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0078-1-1024x576.jpg 1024w, https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0078-1.jpg 2048w\" sizes=\"(max-width: 740px) 100vw, 740px\" \/><\/a><figcaption id=\"caption-attachment-3708\" class=\"wp-caption-text\">Joe and Diane<\/figcaption><\/figure>\n<figure id=\"attachment_3685\" aria-describedby=\"caption-attachment-3685\" style=\"width: 700px\" class=\"wp-caption alignleft\"><a href=\"https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0076.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-3685\" src=\"https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0076.jpg\" alt=\"\" width=\"700\" height=\"525\" \/><\/a><figcaption id=\"caption-attachment-3685\" class=\"wp-caption-text\">Diane with Casey Gwynn and sister Joanne<\/figcaption><\/figure>\n<figure id=\"attachment_3683\" aria-describedby=\"caption-attachment-3683\" style=\"width: 740px\" class=\"wp-caption alignleft\"><a href=\"https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0100.png\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-3683\" src=\"https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0100-740x342.png\" alt=\"\" width=\"740\" height=\"342\" srcset=\"https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0100-740x342.png 740w, https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0100-768x355.png 768w, https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0100-1024x473.png 1024w, https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0100.png 2048w\" sizes=\"(max-width: 740px) 100vw, 740px\" \/><\/a><figcaption id=\"caption-attachment-3683\" class=\"wp-caption-text\">Dr. Eads and Diane<\/figcaption><\/figure>\n<figure id=\"attachment_3682\" aria-describedby=\"caption-attachment-3682\" style=\"width: 450px\" class=\"wp-caption alignleft\"><a href=\"https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0101.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-3682\" src=\"https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0101-450x600.jpg\" alt=\"\" width=\"450\" height=\"600\" srcset=\"https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0101-450x600.jpg 450w, https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0101-768x1024.jpg 768w, https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0101.jpg 1536w\" sizes=\"(max-width: 450px) 100vw, 450px\" \/><\/a><figcaption id=\"caption-attachment-3682\" class=\"wp-caption-text\">Zack Shinar, Diane, and Jessica<\/figcaption><\/figure>\n<figure id=\"attachment_3681\" aria-describedby=\"caption-attachment-3681\" style=\"width: 740px\" class=\"wp-caption alignleft\"><a href=\"https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0078.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-3681\" src=\"https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0078-740x416.jpg\" alt=\"\" width=\"740\" height=\"416\" srcset=\"https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0078-740x416.jpg 740w, https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0078-768x432.jpg 768w, https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0078-1024x576.jpg 1024w, https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0078.jpg 2048w\" sizes=\"(max-width: 740px) 100vw, 740px\" \/><\/a><figcaption id=\"caption-attachment-3681\" class=\"wp-caption-text\">Bellezzo And Diane<\/figcaption><\/figure>\n","protected":false},"excerpt":{"rendered":"<p>In this episode Zack and Joe discuss the 3-stages of Extracorporeal Membrane Oxygenation (ECMO) &#8211; or put another way, this is how to start Extracorporeal Cardiopulmonary Resuscitation (ECPR) in the Emergency Department (ED). It&#8217;s been 4 years since we talked about these basic premises of ECPR. But this time, its highlighted in a very special story.<\/p>\n","protected":false},"author":4,"featured_media":3685,"comment_status":"open","ping_status":"closed","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":[219,82,246,214,279,72,159,56,135,255,215],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/edecmo.org\/wp-content\/uploads\/2017\/12\/IMG_0076.jpg","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p3JzC4-XR","_links":{"self":[{"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/posts\/3711"}],"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=3711"}],"version-history":[{"count":0,"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/posts\/3711\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/media\/3685"}],"wp:attachment":[{"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/media?parent=3711"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/categories?post=3711"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/edecmo.org\/wp-json\/wp\/v2\/tags?post=3711"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}