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.
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? 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.
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.
70: REBOA REDUX – Management of Hemorrhagic Shock in Non-Trauma Patients – with Bellezzo & Zaf Qasim
January 1, 2021: The year following COVID19 Global Pandemic brings us a new horizon - lets appreciate what has happened, learn from our mistakes and begin to look forward.
In this episode Joe Bellezzo talks with Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) expert Dr. Zaf Qasim about NON-TRAUMA applications of aortic compression for control of non-compressible non-trauma torso hemorrhage.
Dr. Qasim is a world expert in REBOA and has been on the podcast:
edecmo.org/35 - REBOA revisited
edecmo.org/49 - the ACEP-ACS joint statement controversy
edecmo.org/59 - Partial REBOA
REBOA in Hemorrhagic Shock from NON-Trauma Mechanisms:
This episode is highlighted by a remarkable case, managed by Emergency Physician Dr. Garrett Sterling, of a 77 year old patient who suffered non-traumatic hemorrhagic shock from an Iliac artery pseudo-aneurysm that had fistulized to the urinary tract. The patient was bleeding to death from a fistula between the common iliac artery and the ureter. You have to listen to Dr. Sterling describe this case. The patient was resuscitated with REBOA and her pathology was fixed by an Iliac Artery stent placed in Interventional Radiology. We discuss this case which highlights the benefit of REBOA as a bridge to definitive hemorrhage control.
Amazing patient who had an Iliac pseudo-aneurysm causing hemorrhagic shock through the urinary tract, resuscitated using REBOA.
Joe and Zaf talk about:
* brief history of managing hemorrhagic shock with aortic occlusion
* 'Knee REBOA'
* Resuscitative thoracotomy
* REBOA in trauma
* REBOA in non-trauma hemorrhagic shock
69: 2020 Synopsis
2020 was a crazy year. This month Zack goes through the biggest ECMO lessons learned in 2020. This is a short concise run through of ECPR, ECMO for COVID, Imaging, and Aortic Dissection. It's a reminder of how organization is so critical to the outcome of your ECMO program. He also reminds us how improvement in these systems of care can lead to survival rates even the believers in ECMO thought were unattainable.
68: ARREST – The First Randomized ECPR Trial Ever
The ARREST Trial is published! Demetris Yannopoulos, Jason Bartos and their army of rockstars have done it! This is the first randomized ECPR trial and it showed tremendous benefit of ECPR compared to traditional therapies. Zack explores this paper and their concurrent publication of process with Demetris. Their two Lancet papers are below
In the news, Jenelle Badulak and her crew at UW saved a hypothermic mountaineer in Seattle. Story here.
Demetris Yannopoulos and Jason Bartos
67: Da DO2: Fundamental ECMO Physiology with Sage Whitmore
Have you ever wondered about how initiating ECMO changes the cardiovascular physiology? Have you wondered what metrics you should be looking at when resuscitating a patient that has a beating heart and a ECMO flow? Dr. Sage Whitmore, an ED Intensivist from Nashville with ECMO training from UMichigan, leads us through the basic to the tough questions of ECMO physiology.online pharmacy
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