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ED ECMO — Health & Fitness
ED ECMO

Resuscitationist-Initiated Extracorporeal Life Support

Latest Episodes:

75: Pulmonary Embolism and ECPR Dec 03, 2021
Show notes

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

75: Pulmonary Embolism and ECPR Dec 03, 2021
Show notes

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

Coute — 74: Do 70 year old’s deserve ECPR? A Deep Dive into the Economics of ECPR Oct 14, 2021
Show notes

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
Show notes

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

Show notes

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

73:The Hyperinvasive Trial with Jan Belohlavek May 24, 2021
Show notes

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
Show notes

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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72: Should We All Switch To Bivalirudin? Mar 25, 2021
Show notes

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? Feb 24, 2021
Show notes

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
Show notes

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

70: REBOA REDUX – Management of Hemorrhagic Shock in Non-Trauma Patients – with Bellezzo & Zaf Qasim Jan 02, 2021
Show notes

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

Show notes

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
Show notes

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

68: ARREST – The First Randomized ECPR Trial Ever Nov 22, 2020
Show notes

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
Show notes

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

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

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

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