ED ECMO

**75: Pulmonary Embolism and ECPR** Dec 03, 2021
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

Hardcover here

**74: Do 70 year old’s deserve ECPR? A Deep Dive into the Economics of ECPR** Oct 14, 2021
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.

Coute

Economic loss of productivity of OHCA

Grosse

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6688510/

**74: Do 70 year old’s deserve ECPR? A Deep Dive into the Economics of ECPR** Oct 14, 2021
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.

Coute

Economic loss of productivity of OHCA

Grosse

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6688510/

73b: Conclusions for Hyperinvasive Trial with Jan Belohlavek May 24, 2021

Here is the conclusion for the interview of Jan Belohlavek and his Hyperinvasive Trial

**73:The Hyperinvasive Trial with Jan Belohlavek** May 24, 2021
Wait…ECPR works?

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?** Mar 25, 2021
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.

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**71: Should We Prioritize VV-ECMO over ECPR?** Feb 24, 2021
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.

**Oslo Study**

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** Jan 02, 2021
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

REFERENCES:

https://pubmed.ncbi.nlm.nih.gov/29922894/

https://pubmed.ncbi.nlm.nih.gov/31799415/

https://pubmed.ncbi.nlm.nih.gov/32707397/

https://pubmed.ncbi.nlm.nih.gov/31668242/

https://tsaco.bmj.com/content/4/1/e000376

https://pubmed.ncbi.nlm.nih.gov/29421694/

https://www.jsomonline.org/FeatureArticle/20202110O’Dochartaigh.pdf

69: 2020 Synopsis Dec 18, 2020

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** Nov 22, 2020

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

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32338-2/fulltext

https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30376-X/fulltext

In the news, Jenelle Badulak and her crew at UW saved a hypothermic mountaineer in Seattle. Story here.

https://www.bbc.com/news/world-us-canada-54959874

Demetris Yannopoulos and Jason Bartos

**67: Da DO2: Fundamental ECMO Physiology with Sage Whitmore** Oct 14, 2020
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

66: Crash VV ECMO Sep 07, 2020

Have you ever wondered how you would crash someone onto VV ECMO? Have you ever wondered where is the best place to put the cannulas? Have stayed up late at night wondering which patients in your department could benefit from VV rather than VA ECMO? Then this is the episode for you!! After a few recent cases of crash VV ECMO in our hospital, we have decided to focus on the subject. Zack gets critical care physician David Willms to answer from a very practical standpoint the who, what, where of crash VVECMO.

65: ECPR Journal Club: Dual Sequential Defibrillation, CT after ECMO, and much, much more May 23, 2020

This month we tackle a number of topics. Garrett Sterling is back again with Zack Shinar to talk about cutting edge resuscitation, ECMO, and the interplay between the two. Dual sequential defibrillation, CT after ECMO initiation, should you perform bystander CPR in the era of Covid, some US ECMO data, and an awesome 3D modeling for ECPR training models. All in one 30 minute podcast!

64: Contraindicated??? – Long Live the Aortic Dissection with Garrett Sterling Apr 23, 2020

In this episode, Zack Shinar introduces a new physician to the podcast - Garrett Sterling. Garrett and Zack discuss the sticky topic of ECMO for aortic dissection. This traverses everything from VA ECMO in ECPR to VVECMO for pulmonary edema. They go through the literature on the subject and make some conclusions based on this data. The ultimate question - "Is Aortic Dissection a Contraindication for ECMO?"

63: Covid and ECMO – Who do we cannulate? with Jenelle Badulak Mar 22, 2020

"Normal life is changing. It is now a covid 19 life" - Bin Cao I write this with some trepidation as well as pride in the role we get to play as we begin the surge of Covid 19 in the United States. Today we will address the use of ECMO in Covid with an expert in ECMO who is in the throws of the worst outbreak of the United States - Seattle, Washington. Jenelle Badulak and I give you a short yet powerful discussion about who we should put on ECMO with Covid. Hosts - Zack Shinar, Jenelle Badulak

62: Jason Bartos Take 2: The Future of ECPR Now Feb 18, 2020

Last month you heard Jason talk about the ECPR program at the University of Minnesota. This month Zack and Jason talk about post initiation care and the crazy ECPR realities that Demetri, Jason and U of M have created. The sky is the limit for their team!

61: Jason Bartos – ECPR Redefined Jan 30, 2020

Jason Bartos and his crew at the University of Minnesota have revolutionized the concept of ECPR for out of hospital cardiac arrests. His crew are interventional cardiologists who take OHCA straight to the cardiac cath lab. They have initiate times of around 6-8 minutes and have neurologically intact survival rates higher than 30%. Below are two of Jason’s recent papers which every person who considers themselves an ECPR fan should pour over with a fine-toothed comb. There is so much in these papers. We split this interview into two pieces because there is so many pearls in it.

60: ECPR 2.0 with Scott Weingart Dec 03, 2019

Today's episode focuses on the differences between ECMO physiology in the patient in cardiogenic shock versus the one in cardiac arrest.

59: Partial REBOA and US PreHospital ECPR Revisited Nov 04, 2019

This month we discuss two different topics we've recently had on the podcast. Albuquerque had started the first US prehospital ECPR program.... and now they have the first patient as well. Jon and Darren will share with us the exciting news. Second, we recently had Matt Martin on the podcast talking about partial REBOA. We got tons of email about this. This month Zaf Qasim and Austin Johnson come on to talk about some of the controversial aspects of partial REBOA. Zaf also gives us a great update on the state of REBOA in the world.

58: First U.S. Pre-Hospital ECPR Program Sep 30, 2019

The U.S. has seen pre-hospital programs spring up in Paris, UK, and Australia. It was thought that due to billing issues this could never happen in America....but it has. Jon Marinaro and Darren Braude have accomplished this against all odds. Zack interviews the two of them on how they were able to accomplish this task amidst the many financial, logistic, and medical problems surrounding this monumental task.

57: The New REBOA catheter – Perfecting the Partial Occlusion Sep 07, 2019

Over the last two years, partial or intermittent REBOA has been thought to be a significant advantage over complete REBOA. How to do this and how to use our current imperfect catheters in this arena is still in question. Matthew Martin and his colleagues at Madigan Medical Center have published the first study using the Prytime's new catheter for partial REBOA. Zack interviews Matt in this episode about his latest paper in Journal of Trauma and Acute Surgery. Dr. Martin is extensively published in the field and offers his insight in the specific flows that maximize survival within the conflicting problems of hemorrhagic shock and lower body ischemia.

56: Pressors, Fluid, or Flow – Optimizing ECMO Physiology Jul 08, 2019

A post arrest patient just got initiated on ECMO. Do you give fluids, add pressors, or increase flow? Marc Dickstein, an anesthesiologist from Columbia University and an expert in the physiology of ECMO, talks with Zack about how to manage these patients, what diagnostics we need and how to optimize your use of the machine. This talk is a must for everyone starting ECPR in their departments.

55 – Anticoagulation of the ECMO Patient with Troy Seelhammer Jun 04, 2019

Do you give heparin to your ECMO patients? Well, let's rethink this. This episode is All Things Anticoagulation! Zack talks with Troy Seelhammer, an intensivist from Mayo Clinic Rochester. He manages ECMO patients in his daily practice there. He has become a master of the subject of anticoagulation. He will talk about heparin, bilvalirudin, or maybe no anticoagulation. He talks about the when to be aggressive and when to cut back. Below is a wonderful synopsis of Troy's thoughts on anticoagulation on pump.

54: Confirmation of Wire Placement with Sacha Richardson May 08, 2019

In this episode, Sacha Richardson talks with Zack about a problem common to all ECPR programs- how do we confirm the placement of the wires? During chest compressions and even in patients with a pulse, confirmation of which vessel you have cannulated can be difficult. Sacha shares some tricks and trips on how to get real time confirmation of the wires. Sacha also gives us a preview of some of the exciting endeavors that he has undertaken in Melbourne with pre-hospital ECMO.

53b: Resuscitationist Inserted Distal Perfusion Catheter with Chris Couch Apr 04, 2019

In this episode, we again explore the world of the distal perfusion catheter. You heard from Joe Dubose the vascular surgeons point of view; now let's see how non-surgeon resuscitationists are dealing with this problem. You will hear from Chris Couch, a critical care trained emergency physician from Dallas Texas and his colleague Omar Hernandez who have some novel thoughts and experiences related to when and how we insert these catheters. You will hear about checking compartment pressures, poor man's way to "fluoro" your catheter, and much more.

53: Distal Perfusion Catheter with Joe Dubose Apr 01, 2019

Episode 53 is all about the distal perfusion catheter12. We are inserting a 15-19 Fr catheter into the femoral artery. This limits the flow of blood to the affected extremity. Many institutions have gone to mandatory distal perfusion catheters. This episode is all about those catheters - when, how, which, and where. Joe Dubose, the world reknown vascular and trauma surgeon, joins us to discuss the details of this important piece of post pump initiation.

52: Brain Freeze- Selective Retrograde Cerebral Perfusion for Intra-Arrest Neuroprotection Mar 05, 2019

We've all heard of therapeutic hypothermia. Some of us have heard of deep hypothermia for traumatic arrest. But what about deep regional hypothermia of brain for cardiac arrest! Zack interviewed Rob Schultz, a CT surgeon resident from Calgary who is doing research on deep hypothermia of the brain using some of the tactics that are utilized in operating room. His stuff is mind blowing!

51 – Proximal Balloon Occlusion for Cardiac Arrest Feb 12, 2019

You've heard of ECMO for cardiac arrest- utilizing a mechanical pump to aid in perfusion of the coronaries. What if you can't do ECMO? What if your resources are such that simply can't lug a 10 kilogram machine out into the field? Well, Jostein Brede may have something for you to consider. He and several other places worldwide are on the forefront of using a REBOA catheter to occlude the proximal aorta during chest compressions in hopes that coronary perfusion pressure increases. This would subsequently improve chance of return of spontaneous circulation and overall survivorship. Maybe this is the band-aid that can be used in austere environments like rural Norway where the temperatures are extreme, the people are sparse, but the physicians are motivated.

50b Inter-Facility Transport of ECMO patients Part 2 of 2 Dec 05, 2018

This is part 2 of Transport of ECMO patients. Mikael Broman is one of the world's leaders on ECMO transport. He works at the Karolinska institute in Sweden and has and continues to publish in the arena of ECMO transport. As you will see, he offers a world of experience and certainly some critical information that we would all benefit from listening to. I'm a smarter ECMO-tologist as a result of Micke!

50a Inter-facility Transport of ECMO patients Part 1 of 2 Dec 05, 2018

This month we are looking at how to transport patients from one facility to another on ECMO. This is difficult task full of potential catastrophes. Zack interviews Leon Eydelman, an ER/Critical Care physician from Chicago, and Michael Broman out of Karolinska in Sweden. Leon will be bringing us up to speed on what to do, potential fails, and how to start the process of setting up a transport process for ECMO patients. Dr. Eydelman will be teaching a new section at Reanimate this January specifically geared toward the transport of patients. So if you are a nurse, medic, perfusionist, RT, or physician involved in the transport of ECMO patients you will not want to miss Leon's section Sign up at Reanimateconference.com. Part 2 of this podcast includes the interview with Dr. Broman which will blow your mind. So much great stuff in both of these interviews.

49 – You Can’t Spell REBOA without the ER – Endovascular Resuscitation of the Trauma Patient – Zaf Qasim Oct 12, 2018

n this episode, Zack Shinar interviews Zaf Qasim about the recent controversies with ACEP and ACS about who can do REBOA. Zaf is one of the world's experts on REBOA and he's an ER doc! Zaf works at the University of Pennsylvania, trained in London as well as Shock Trauma in Baltimore and teaches at Reanimate. When you come to the essence of this episode, the question is what is the emergency physician's role in the trauma resuscitation? Both Zaf and Zack agree; we need to be the resuscitationist in the trauma suite. We need to manage the airway and then quickly take over the arterial and venous access, interpret the transduced pressures, manage the massive transfusion protocol and be ready to insert the REBOA catheter while the trauma surgeon is involved with the left chest, the source of bleeding and where the next destination for this patient will be.

EDECMO 48: When Should I Transport a Cardiac Arrest? Aug 10, 2018

This part two of August 2018. We are now tackling the difficult question of when to transport cardiac arrests if I have ECMO available? Brian Grunau is an expert in this question. Brian has become a giant in the world of ECMO. His research, leadership and experience have pushed the Canadian ECPR contingency to the forefront. Brian gives us some insight on what factors I should consider and when should I transport.

EDECMO 47: ECMO Donazione: Organ Transplantation with Velia Antonini Aug 04, 2018

Over this last year we have had episodes on organ donation and decision to transport. This month we are revisiting two topics with two amazing people in two separate episodes. Here, I interviewed Velia Marta Antonini. Velia works in Italy where several of the great ECMO donation papers have originated. She explains why this research is coming from Italy, what the process looks like, and the implications of this for other countries. Check out her slides below.

EDECMO 46: Wire Assistant Jul 06, 2018

Well, it only took us seven years to figure this one out. The wire assistant has been the key advancement of 2018 for placement of ECMO cannulas. In this episode, Zack and Joe talk through this process after an interview with Alyssa Baldini. Alyssa was one of our first true wire assistants and has been instrumental in getting cannulas in faster and safer. We discuss how the wire assistant aids in sterility and getting the artery on the first stick. Bottom line - train someone at your shop to be an expert wire assistant.

EDECMO 45: ECMO in Sepsis May 10, 2018

In this episode, Zack talks with Heidi Dalton about ECMO use in Sepsis. This is another controversial area with pediatric literature showing strong results while the adult results have been less impressive. Heidi has been a key figure in both adult and pediatric ECMO. She is the former chair of the yearly ELSO conference. She is a professor at both George Washington University and Virginia Commonwealth University. Her background is in pediatric critical care. She currently works at INOVA in Virginia where she is the director of adult and pediatric ECMO. So the question for today is should we be utilizing ECMO for sepsis?

EDECMO Crash Episode – Demetris Yannopoulos on ECPR-the Minneapolis Way Apr 08, 2018

Yanno on ECPR

EDECMO 44: Bob Bartlett: Peristaltic Pumps, Hollow Fibers, and the History of ECMO Mar 22, 2018

In this episode, Zack interviews Bob Bartlett from the University of Michigan. He is truly the godfather of ECMO and has revolutionized the world with his leadership and innovation. They discuss the history of ECMO and roller pumps and bubble oxygenators were clearly inferior to their current counterparts - centrifugal pumps and hollow fiber oxygenators. They also discuss anticoagulation and how Bob feels direct thrombin inhibitors are superior. They also discuss the future of ECMO and how peristaltic pumps may be where we are headed.

EDECMO 43: The Cutdown Feb 20, 2018

In this episode, Alice Hutin of the Paris SAMU talks about the modified cutdown approach to cannula insertion. She is an emergency physician who is one of four physicians who take call on the pre-hospital ECMO ambulance. She describes the process of their modified cutdown. First, incision through the skin is made 2 cm below inguinal crease. Second, blunt dissection down through the soft tissue. This is best done with your fingers. Third, place a needle through the distal skin and visualize it pass into the vessel. From there, you cannulate as with percutaneous. Alice’s recent paper shows a 6% failure rate with this technique in skilled hands.

EDECMO 42: Organ Transplantation On ECMO Jan 16, 2018

In this episode, we tackle the subject of organ transplantation on ECMO. 2017 featured several articles showing the efficacy of ECMO for organ transplantation. In Italy, 56% of total potential patients were successfully transplanted. The success of these transplants have been comparable to patients not on ECMO. Zack Shinar interviews Lionel Lamhaut, ECMO specialist from Paris, and Cyrus Olsen, ethicist from the University of Scranton, to dive into some of the deeper questions including financial implications, ethical angles, and research extrapolations. Join Zack, Lionel and Cy at Big Sick 18 (bigsick18.org) in Zermatt Switzerland on February 7-9th,, 2018!! 1: Christopher DA, Woodside KJ. Expanding the Donor Pool: Organ Donation After Brain Death for Extracorporeal Membrane Oxygenation Patients. Crit Care Med. 2017 Oct;45(10):1790-1791. doi: 10.1097/CCM.0000000000002633. PubMed PMID: 28915178. 2: Bronchard R, Durand L, Legeai C, Cohen J, Guerrini P, Bastien O. Brain-Dead Donors on Extracorporeal Membrane Oxygenation. Crit Care Med. 2017 Oct;45(10):1734-1741. doi: 10.1097/CCM.0000000000002564. PubMed PMID: 28640022. 3: Casadio MC, Coppo A, Vargiolu A, Villa J, Rota M, Avalli L, Citerio G. Organ donation in cardiac arrest patients treated with extracorporeal CPR: A single centre observational study. Resuscitation. 2017 Sep;118:133-139. doi: 10.1016/j.resuscitation.2017.06.001. Epub 2017 Jun 12. PubMed PMID: 28596083. 4: Dalle Ave AL, Bernat JL. Donation after brain circulation determination of death. BMC Med Ethics. 2017 Feb 23;18(1):15. doi: 10.1186/s12910-017-0173-1. PubMed PMID: 28228145; PubMed Central PMCID: PMC5322624. 5: Larsson M, Forsman P, Hedenqvist P, Östlund A, Hultman J, Wikman A, Riddez L, Frenckner B, Bottai M, Wahlgren CM. Extracorporeal membrane oxygenation improves coagulopathy in an experimental traumatic hemorrhagic model. Eur J Trauma Emerg Surg. 2017 Oct;43(5):701-709. doi: 10.1007/s00068-016-0730-1. Epub 2016 Nov 4. PubMed PMID: 27815579; PubMed Central PMCID: PMC5629226. 6: Dalle Ave AL, Shaw DM, Gardiner D. Extracorporeal membrane oxygenation (ECMO) assisted cardiopulmonary resuscitation or uncontrolled donation after the circulatory determination of death following out-of-hospital refractory cardiac arrest-An ethical analysis of an unresolved clinical dilemma. Resuscitation. 2016 Nov;108:87-94. doi: 10.1016/j.resuscitation.2016.07.003. Epub 2016 Jul 20. Review. PubMed PMID: 27449821. 7: Fan X, Chen Z, Nasralla D, Zeng X, Yang J, Ye S, Zhang Y, Peng G, Wang Y, Ye Q. The organ preservation and enhancement of donation success ratio effect of extracorporeal membrane oxygenation in circulatory unstable brain death donor. Clin Transplant. 2016 Oct;30(10):1306-1313. doi: 10.1111/ctr.12823. Epub 2016 Sep 5. PubMed PMID: 27460305. 8: Jasseron C, Lebreton G, Cantrelle C, Legeai C, Leprince P, Flecher E, Sirinelli A, Bastien O, Dorent R. Impact of Heart Transplantation on Survival in Patients on Venoarterial Extracorporeal Membrane Oxygenation at Listing in France. Transplantation. 2016 Sep;100(9):1979-87. doi: 10.1097/TP.0000000000001265. PubMed PMID: 27306536. 9: Migliaccio ML, Zagli G, Cianchi G, Lazzeri C, Bonizzoli M, Cecchi A, Anichini V, Gensini GF, Peris A. Extracorporeal membrane oxygenation in brain-death organ and tissues donors: a single-centre experience. Br J Anaesth. 2013 Oct;111(4):673-4. doi: 10.1093/bja/aet323. PubMed PMID: 24027145.

EDECMO 41 – The 3 Stages of ECPR – Diane’s Story Dec 30, 2017

In this episode Zack and Joe discuss the 3-stages of Extracorporeal Membrane Oxygenation (ECMO) - or put another way, this is how to start Extracorporeal Cardiopulmonary Resuscitation (ECPR) in the Emergency Department (ED). It's been 4 years since we talked about these basic premises of ECPR. But this time, its highlighted in a very special story.

EDECMO 40: EROCA – The trial that asks “Should ER Docs Initiate ECPR?” Nov 02, 2017

EROCA - University of Michigan - Gunnerson/Shinar Should Emergency Physicians initiate ECMO on arresting patients? That is the question that Kyle Gunnerson from the University of Michigan (UMich) is asking with their new trial - EROCA. UMich has had a robust ECMO program for over 30 years and recently they have received a grant to fund an out of hospital cardiac arrest protocol for emergency physician initiated ECPR. In this episode, Zack asks Kyle how this trial is being undertaken with key side points on how to start a program, how to train the personnel, and how to circumnavigate the many roadblocks we commonly face in the development of an ECMO program. They talk about the limitations of running a trial with physicians with no prior experience in ECPR initiation as well as the novel resuscitation strategies that UMich is deploying in all of their cardiac arrest patients.

EDECMO 39: Who Do We Put On ECMO? – New Data on Prognostics Oct 06, 2017

In this episode Zack interviews the first authors of the three biggest papers this year dealing with the question of “Who should I put on ECMO?” Guillaume Debaty of Grenoble, France published a paper outlining what prognostic factors are important. Guillaume's data shows importance of short low times, lower lactates and higher pH values. The real question is what number for each of these should we consider a hard stop on initiation. This is followed up by Josh Reynolds who along with Ben Singer out of the UK published a paper utilizing cardiac arrest data from the PRIMED trial. He showed that even patients with all the advantageous characteristics of traditional ECMO inclusion criteria had poor survivals once they have had >30 minutes of chest compressions. With many ECMO studies having average arrest to initiation times of > 60 minutes, Josh’s paper certainly makes us view favorably the 30% survival outcomes that we are seeing worldwide. This in no way substitutes for a randomized trial but does offer some guidance on what the expected survival of a patient with a witnessed arrest, short low flow times, and age < 65. We conclude with Nate Haas out of the University of Michigan who utilitzed the ELSO database to show that age was not predictive of survival. This may push us towards including older patients in our inclusion criteria, but more data is definitely needed on this.

Crash Episode: Iowa OHCA ECMO Save – with Andrew Karl Terry Sep 07, 2017

Mini episode - This is a great example of where a little persistence with your colleagues can help save someone's life. Dr. Andrew Karl Terry, having had only limited exposure to ECMO, was able to encourage his Cardiologists to put a witnessed VF patient on ECMO. The rest is history!

EDECMO 38 – ECMO and Trauma – with Pal Ager-Wick and Magnus Larsson Aug 28, 2017

This episode is all about ECMO in trauma - not the usual ARDS, TRALI VV-ECMO - we’re talking about VA ECMO for the acutely dying trauma patient. Zack interviews Pål Ager-Wick from Tromso Norway, and Magnus Larsson from the Karolinska Institute in Stockholm. We talk about everything from how ECMO helps the hemorrhaging trauma patient to the futuristic “Emergency Preservation and Resuscitation” concept being done in Baltimore now.

EDECMO 37 – Nate’s Story Jul 21, 2017

Jake is an Emergency Physician from Santa Cruz California whose interest in resuscitation was put to the fullest test when his own son had a cardiac arrest. This is the amazing retelling of that day in November when what Jake learned in an EDECMO workshop was utilized in a dramatic fashion. This is a story of two heros: Jake and his son Nate.

Crash Episode – MicroDissection of Yannopoulos’ ECMO Method Jul 15, 2017

The University of Minnesota Cath Lab Cannulation Method

EDECMO 36 – Crushing the Nihilism of Cardiac Arrest – with Demetris Yannopoulos Jun 09, 2017

In this podcast episode, Zack interviews Demetri Yannopoulos from the University of Minnesota. Demetri has organized Minneapolis into arguably the most impressive ECPR city in the world. He has changed the mindset of out of hospital refractory ventricular fibrillation care from “stay and play”, the philosophy that medics should stay at the scene and provide care until ROSC (return of spontaneous circulation) or until the patient is pronounced dead. In Minneapolis, a patient who who arrests in Yannopoulos’ catchment area gets three shocks. If the patient does not get ROSC then they are immediately transported to the University of Minnesota using LUCAS mechanical chest compression device. The patient bypasses the emergency department and goes directly to the cath lab. In the cath lab, Demetri, or one of his partners, cannulates and initiates ECMO with an average time of 6 minutes!!! In his first 90 patients he has had a 45% neurologically intact survivorship. Patients are getting to the cath lab on average 60 minutes after their arrest. In this cohort, you would expect a less than 1% survival. We can use Dr. Yannopoulos’ model to expand the use of ECPR in many other systems. The real question is do we have champions like Demetri who will rise to the calling!

EDECMO 35 – REBOA REVISITED! Apr 07, 2017

REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) is used to gain proximal control over non-compressible hemorrhage below the diaphragm. In this episode, Zack takes a deep dive into REBOA implementation, physiology, and complications with four of the biggest movers in the world of REBOA:

EDECMO 34 – The Day After REANIMATE – with Dr. Sean Deitch Mar 15, 2017

In this episode, Joe talks with Dr. Sean Deitch, a non-academic Emergency Physician practicing in San Diego, California. Dr. Deitch attended REANIMATE 3 - which just finished 2 weeks ago...and has an amazing story to tell. You'll have to listen to the episode... REANIMATE 4 is September 21-22, 2017 and features guest faculty member Stephen Bernard - coming all the way from Melbourne, Australia - and best know from the original therapeutic hypothermia trials and CHEER. R3 was amazing and R4 will be even better!!

EDECMO 33a – “Bringing Down the House” by Zack Shinar (from RESUSfest 2016) Jan 26, 2017

In this episode of the EDECMO podcast, Zack describes how to use the concept of 'TEAM PLAY", much like the gang from the classic novel "Bringing Down the House" by Ben Mezrich, to optimize outcomes after cardiac arrest....with, or without, ECPR.

EDECMO 32 – Archimedes Screw: Is Impella the Future of Mechanical Circulatory Support? Dec 07, 2016

In this episode we explore two very different applications of the Impella® device - a percutaneously-placed temporary ventricular assist device (VAD) sold by Abiomed (no financial disclosures). These VADs work by the use of a micro-axillary pump which is typically placed by interventional cardiologists under fluoroscopy. The inlet of the pump is placed in the ventrical while the outlet rests just above the aortic valve.

EDECMO 31 – Anaphylaxis & Epi-Pens. Are we ready for VV-ECMO in the Emergency Department? Oct 11, 2016

Here is a case of a young man who presented to the Emergency Department with profound anaphylaxis. This was a "CAN Intubate/CAN'T VENTILATE" scenario: Max Epinephrine Max antihistamines Max steroids Max ventilator What options do you have? Find out in this episode.

EDECMO 30 – Post-Arrest ECMO Critical Care Management with Deirdre Murphy Sep 09, 2016

Post Pump Crit Care

EDECMO 29 – ECMO in Hypothermic Cardiac Arrest – with Torvind Naesheim of Norway Jul 13, 2016

Joe interviews Torvind Naesheim, an intensivist and cardiothoracic anesthesiologist from Norway, on the management of accidental hypothermic arrest using ECMO

EDECMO 28 – The University of Utah EDECMO Experience and the ERECT Collaborative Jun 09, 2016

Zack talks with the ED ECMO team from the University of Utah about how they established their ECPR program.

EDECMO 27 – A Real-World Case of a Crashing Multi-Drug OD Patient Saved with ED ECMO Apr 28, 2016

This is a real-world case of a multi-drug overdosed patient that would have died without ECMO. We talk about ECMO being a bridge to an intervention. Well, sometimes ECMO is a bridge to metabolism of drug/med that they OD'd on.

EDECMO 26 – “ECPR is a Step Too Far” – Ho vs. Bellezzo: a SMACCback Chicago Cage Match Mar 02, 2016

Are you ready for this rumble in the urban jungle?? Chris Ho vs Joe Bellezzo in the no holds barred debate about whether ECMO CPR is a step too far? The next cage match from SMACC Chicago.

EDECMO 25.5 – (Part 2) an EDECMO short with Jim Manning – on location with the SAMU pre-hospital ECMO team in France Nov 30, 2015

In followup to our discussion with Jim Manning MD (@JManning_UNC) and Lionel Lamhaut (@LionelLamhaut) MD of the Service d’Aide Médicale Urgente (SAMU) for EDECMO Episode 25, the guys spent the last few days 'just hanging out in Paris."

EDECMO 25 – ‘Ze ECMO TEAM.’ Manning and Lamhaut: Updates on ECMO, the new 7F REBOA Catheter, and Pre-hospital ECMO in France Nov 19, 2015

In this episode, Zack interviews Jim Manning MD (University of North Carolina) and Dr. Lionel Lamhaut from the famed French SAMU (Service d'Aide Médicale Urgente). REBOA. SAAP. Pre-Hospital ECMO. Its all here.

The Rat Pack: Another Year of EDECMO (2014/2015) – Video Oct 04, 2015

The Rat Pack: The Last Year of EDECMO!

EDECMO 24 – Weaning VA-ECMO, with Deirdre Murphy Sep 10, 2015

In this episode, Zack and Joe talk with Deirdre Murphy, the Deputy Director of the ICU, director of the cardiothoracic ICU at the Alfred Hospital in Melbourne, Australia. The Alfred has put itself on the map in so many ways over the past decade. Home to Stephen Bernard (of the original Hypothermia after ROSC without RONF fame), Chris Nickson (@precordialthump, @I_C_N, @intensiveblog, #SMACC, lifeinthefastlane.com), and good friends Jason McClue, Steve McGloughlin, Josh Ihle, Paul Nixon, and Deirdre Murphy, The Alfred is becoming a mecca for advanced resuscitation and ECMO/ECPR. In this episode we sat down with Dr. Murphy to discuss the nuances of weaning a patient from ECMO. As ED Docs, Zack and I find ourselves at the heroic end of the resuscitation spectrum when the dying patient goes on pump...but what happens at the other end? What happens in the hours, days, and weeks that follow? Listen to this episode to find out...

EDECMO 23 – ORNATO LIVES! – How ECMO Saved a Pillar of Resuscitation Jul 14, 2015

Joe Ornato, a pillar in the world of resuscitation, suffered a massive PE and arrested upon arrival to the Virginia Commonwealth University Emergency Department in April 2015. How it all unfolded is amazing. Listen to this episode to hear the details...

EDECMO 22 – Managing the Crashing Tox Patient with ECMO – with Leon Gussow & Steve Aks from The Poison Review Jun 15, 2015

In this episode Scott, Zack and Joe were all in the same room...in a conference room at the University of North Carolina, Chapel Hill - 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.

REANIMATE SAN DIEGO 2016: February 25-26, 2016 May 25, 2015

REANIMATE is a 2-day conference that will teach you everything about Resuscitative ECMO and Extracorporeal Cardiopulmonary Resuscitation (ECPR). The conference will be hosted by Zack Shinar, Scott Weingart, and Joe Bellezzo

EDECMO 21- The Vienna Project: A Randomized-Controlled Trial of ECPR for Out-Of-Hospital Cardiac Arrest May 21, 2015

In this episode Zack talks with Dr. Schoeber about their newest endeavor, the holy grail: a randomized-controlled trial comparing "Load & Go" (transporting OHCA patients to the ED immediately for consideration of ECMO) vs. "standard care" (staying on scene until the patient achieves either ROSC or is pronounced dead). Zack and Andreas talk about the impact this could have on the future of ECPR for OHCA.

EDECMO 20 – The Golden Hour & the Rule of 3’s: Optimizing the Critical First Hour on Heart-Lung Bypass Apr 11, 2015

In this episode, Joe talks about that first critical hour on Heart-Lung Bypass. What are the most common and critical clinical scenarios that the ECMO operator faces in that first hour on pump? Listen to this episode to find out.

ECMO Simulation Model Built by Zack!! Mar 20, 2015

Using parts purchased at Home Depot, Zack took apart a Tall Paul Anatomy Mannequin and built the whole thing from scratch. This is how it went down!

EDECMO 19 – ECPR for Out-of-Hospital Cardiac Arrest Japanese-Style! Feb 19, 2015

Tetsuya Sakamoto is the principal investigator of a multi-center prospective observational study that was just recently published in the journal Resuscitation: Resuscitation. 2014 Jun;85(6):762-8. Zack and Joe met with Dr. Sakamoto during the 2014 AHA RESS conferences and talked all things ECPR. After that, Shinar sat down with Dr. Sakamoto to get his take on how the Japanese EMS system is setup and how they are able to implement ECPR into their resuscitation protocols.

EDECMO 18 – Remote Ischemic Conditioning – with Graham Nichol Jan 05, 2015

In this episode Zack & Joe talk with Graham Nichol about how to use remote ischemic conditioning to reduce ischemia-reperfusion injury after cardiac arrest.

EM:RAP Mini – Zack & Joe recap AHA 2014: ‘bleeding edge’ interventions in the ED Dec 22, 2014

In this short segment that was generously produced and offered by the EM:RAP team, Zack and Joe recap some the the big topics from the American Heart Association 2014 conference in Chicago.

EDECMO 17 – The Reanimateur: Lionel Lamhaut on Pre-Hospital ECPR Dec 10, 2014

In this episode Zack talks with Lionel Lamhaut, a physician who is heading up their pre-hospital ECMO program. Yes, they are really doing ECMO in the field.

EDECMO 16: The End-of-Life Matrix & The Ethics of Advanced Resuscitation with Dr. Cyrus P. Olsen III, D.Phil. Nov 20, 2014

Zack & Joe talk with Dr. Cyrus Olsen about the challenges of deciding who does, and who doesn't, get advanced resusctition.

EDECMO 15: The CHEER Trial & Part 2 of our Interview with Dr. Stephen Bernard Oct 15, 2014

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.

EDECMO Episode #14: ECPR with Stephen Bernard 1/2 Sep 30, 2014

In today's episode, Joe and Zack interview Dr. Stephen Bernard about Extracorporeal Cardiopulmonary Resuscitation (ECPR) and how they do it the Alfred in Melbourne, Australia.

Evid-ECMO 2: Veno-Venous ECMO in ARDS – The CESAR Trial & ANZ-ECMO Sep 26, 2014

Critical Review of 2 of the big papers on VV-ECMO for ARDS.

EDECMO # 13 – Does Pseudo-PEA Exist and What Should You Do About It Sep 01, 2014

The 3 of us discuss all things PEA

Evid-ECMO (Evidence for ECMO): Critical Analysis of the ECMO literature #1 Aug 23, 2014

Zack and Joe and discuss two high-impact articles that compare conventional CPR to ECPR.

EDECMO Episode 12 – The Nurse-Based ECMO Program at Sharp Memorial Hospital with Suzanne Chillcott RN, BSN Aug 04, 2014

In this episode Joe talks with Suzanne Chillcott, the Mechanical Circulatory Support (MCS) Lead RN at Sharp Memorial Hospital to discuss the nuts and bolts of establishing a "nurse-run" ECLS program.

Video: “Bring Me Back to Life” Conference in Montreal; October 21, 2014 Jul 16, 2014

Video Promo for the "Bring Me Back to Life" conference coming up on October 21, 2014 in Montreal!

EDECMO Episode 11 – The Paris ECMO Course Jul 11, 2014

Highlights from the Paris ECMO Course

EDECMO Episode 10 – “Sequencing” – Ultrasound Priorities During ECPR Jun 29, 2014

~Based on a listener voicemail message, this episode focuses on the cognitive task analysis of ultrasound during ECPR.

EDECMO Episode 9 – The Antithesis of ECPR: African Ingenuity! Jun 02, 2014

When your only option is to put the horse before the cart you focus on the basics: like history and physical exam, not ECMO!

EDECMO Episode 8 – “Prime Time!” – prepping the ECMO circuit for action! Apr 28, 2014

Priming the ECMO Circuit...

EDECMO Episode 7 – Dan Herr on Choosing VV Candidates and Weaning Apr 16, 2014

Who should get VV ECMO and when should you take it off

EDECMO Episode 6 – On Life & Death with Peter Rosen Mar 28, 2014

Joe talks with Peter Rosen, one of the Godfathers of Emergency Medicine, on the topic of life & death

Episode 5 – Cognitive Task Analysis of Stages I and II of Extracorporeal CPR Mar 13, 2014

Joe and I discuss in excruciating detail how to execute Stages I and II of ECPR

Steven Bernard on the CHEER Trial from Intensive Care Network Mar 11, 2014

Bernard on CHEER from ICN

Episode 4 – The Tactical Approach to the Cardiac Arrest Mar 01, 2014

In this episode we talk about how protocols, defined roles, and pre-planned choreography of a medical code works. And we also do a few things different than you...

Resuscitative ECMO Interview from EMCrit.org Feb 14, 2014

This interview with Joe Bellezzo is what caused Scott to pursue ECLS.

Episode 3 – Who the HELL do we put on ECMO during Arrest? Feb 12, 2014

Who Gets ECPR and Who Doesn't? This may be the hardest question we deal with when a patient arrives and ECPR is a consideration.

Episode 2 – The Three Stages of ECPR Feb 07, 2014

In this episode, Joe and Zack discuss the three stages of ECPR initiation.