EDECMO.org is a non-commercial source to discover the life-saving potential of resuscitative extra-corporeal membrane oxygenation (ecmo) and extra-corporeal life support (ecls). We will teach you the skills and break down the logistics to allow resuscitationists to initiate ECMO in the ED or ICU.
75: Pulmonary Embolism and ECPR
In this short episode, Zack makes two points. One, it was tough to get to where we are with ECMO acceptance. Two, cardiac arrest patients in PEA should be considered for ECPR. Below is the full editorial Zack and Alice did recently in the Journal of Resuscitation on the topic. It was born out of a fantastic German article centered looking at registry outcomes for PE and ECMO.
Full Free Link to Editorial (until January 2022) - https://authors.elsevier.com/a/1eAXK_6ryqqpRd
Article link - https://www.resuscitationjournal.com/article/S0300-9572(21)00403-2/fulltext
Get the Textbook from ELSO - ebook click here
74: Do 70 year old’s deserve ECPR? A Deep Dive into the Economics of ECPR
Have you ever pondered whether all the work over ECPR was worth it? Even if you did save a few patients, does this really make sense from a societal standpoint? Am I giving up my life on a project where my efforts could be better elsewhere? Then this episode is for you (and me). This month I talk with Melissa Barnes and Ryan Coute about the economics of cardiac arrest and specifically ECPR. Ryan has just published a great paper in Resuscitation on the costs on OHCA. We will talk with Ryan and Melissa Barnes, ECMO manager at Sharp Memorial Hospital about benefits and costs to society of OHCA and ECMO. I learned several pearls from Ryan's paper as well as a paper by Grosse that Ryan references. Below are the links to both papers with a couple graphs to try to wrap your head around.
Economic loss of productivity of OHCA
73b: Conclusions for Hyperinvasive Trial with Jan Belohlavek
Here is the conclusion for the interview of Jan Belohlavek and his Hyperinvasive Trial
73:The Hyperinvasive Trial with Jan Belohlavek
To the believers, this has been a foregone conclusion. To the rest of the world, the question of whether ECPR improves cardiac arrest survivorship has been in question. Jan Belohlavek and his Prague colleagues just presented their 8 year data showing better outcomes in cardiac arrest patients that got a grouped therapy of early transport, prehospital targeted temperature management, mechanical chest compressions, and ECMO over those who got a traditional resuscitation. This study is key and contrasts to the Oslo study that we reviewed just a few months earlier. Jan speaks with Zack about the details of the results and what were the keys to their success.
Hyperinvasive trial study proposal - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3492121/
Jan's slides on Hyperinvasive Results
72: Should We All Switch To Bivalirudin?
Heparin has been the mainstay of anticoagulation for ECMO patients for years. In recent years, this has been challenged. Bivalirudin has become a potential better anticoagulant. Troy Seelhammer in EDECMO episode 55 gave us some insight into this. This month Ryan Rivosecchi and his crew at UPitt have released their findings in Critical Care Medicine. This retrospective study suggests great improvement in major bleeding in patients who received Bivalirudin compare to Heparin (40.7% vs 11.7%, p 0.001). Listen to Ryan and Zack discuss anticoagulant use in ECMO patients in this month's episode.
Rivosecchi RM, Arakelians AR, Ryan J, Murray H, Padmanabhan R, Gomez H, Phillips D, Sciortino C, Arlia P, Freeman D, Sappington PL, Sanchez PG. Comparison of Anticoagulation Strategies in Patients Requiring Venovenous Extracorporeal Membrane Oxygenation: Heparin Versus Bivalirudin. Crit Care Med. 2021 Mar 15. doi: 10.1097/CCM.0000000000004944. Epub ahead of print. PMID: 33711003.
71: Should We Prioritize VV-ECMO over ECPR?
In this episode, we dive into the abyss of resource allocation. Much of the world is saying that the limited number of ECMO circuits should be used for COVID induced lung injury. This means that ECPR initiatives have been shut down or severely limited. Is this the right thing to do? What does the data say? What strategy gives the most benefit to the most people? Make sure to get CPR Certification Cleveland so you can always be prepared in case of any emergency.
Zack invited Brian Grunau to discuss these topics as well as a recent ECPR paper out of Norway and study dealing with signs of life during CPR. Find more information about CPR Certification Wichita to keep saving lives and helping people in need.
Alm-Kruse K, Sørensen G, Osbakk SA, Sunde K, Bendz B, Andersen GØ, Fiane A, Hagen OA, Kramer-Johansen J. Outcome in refractory out-of-hospital cardiac arrest before and after implementation of an ECPR protocol. Resuscitation. 2021 Feb 10;162:35-42. doi: 10.1016/j.resuscitation.2021.01.038. Epub ahead of print. PMID: 33581226.
Signs of Life Study
Debaty G, Lamhaut L, Aubert R, Nicol M, Sanchez C, Chavanon O, Bouzat P, Durand M, Vanzetto G, Hutin A, Jaeger D, Chouihed T, Labarère J. Prognostic value of signs of life throughout cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest. Resuscitation. 2021 Feb 17:S0300-9572(21)00077-0. doi: 10.1016/j.resuscitation.2021.02.022. Epub ahead of print. PMID: 33609608.
Very informative perspective
I’m glad I came across the podcast, out of sheer curiosity, on the topic of ECMO.
As a perfusionist for nearly eight years, I really appreciate the podcast hosts perspective on this crucial care modality. I try to be a lifetime learner and I am open to learning something new.
Keep these podcasts going; which with the ever evolving discipline of medicine, there will always be something new to discuss.
Also, is there a way to get the first half of the earlier podcasts? Seems like Itunes is only post episode 28 and up; I don’t mind if the earlier ones may be outdated information. Some thought processes and strategies may be timeless.
These guys truly know their stuff!
What a great podcast full of detailed and thoughtful information.
Presented so that even students could understand and follow