Podcasts about ecmo cpr

The crew continues with Dr. Frank Ford and Dr. Colin McCluskey further discusscussing EMS professionals utilizing ECMO CPR. They continue define how to spread the reach and implementation of this new CPR treatment technology.

Dr. Frank Ford and Dr. Colin McCluskey join the Caleb and Scott to further discuss EMS providers performing ECMO CPR. In part 2, we discuss application parameters such as a BLS-only crew, DNR patients, the age patients and geographical factors.  

Dr. Frank Ford and Dr. Colin McCluskey join the Caleb and Scott to discuss EMS providers performing ECMO CPR. It's not really that new of a concept. But new to EMS within the UH EMS Institute medical direction system. Exciting updates.

This Q&A features Chaturi Dissanayake and took place at the Critical Care Update Workshop at CODA22, which took place in Melbourne in September 2022. For more information about the CODA Project, go to: https://codachange.org/ 

This presentation was delivered by Chaturi Dissanayake as part of the Critical Care Update Workshop at CODA22, which took place in Melbourne in September 2022. For more information about the CODA Project, go to: https://codachange.org/ 

Welcome back to the podcast! ECMO-CPR is a growing conversation in the world of cardiac arrest management. This month we have a look at a paper which adds some great evidence to the overall picture; with an RCT on ECPR in refractory of out of hospital cardiac arrest. How will this compare to the amazing results from the ARREST trial? Next up is a really informative paper looking at the utility of ultrasound in suspected testicular torsion in children, this may make a difference to your investigation strategy. Lastly we look a a paper describing the journey of a quality improvement project on paramedic intubation and see the phenomenal results that the method led to. Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Simon & Rob

In this episode, we discuss the recently published RCT in NEJM, which evaluated the efficacy of ECMO CPR ( eCPR) in patients with OHCA secondary to a shockable rhythm. 

Contributor: Aaron Lessen, MD Educational Pearls: Extracorporeal Membrane Oxygenation (ECMO) has been attempted as an adjunct to CPR during cardiac arrest but few studies on outcomes exist  One prior small study stopped early when it showed ECMO with CPR (ECPR) was significantly superior to CPR Recent large, multicenter randomized control study in Netherlands evaluated neurologic outcomes in CPR versus ECPR  At 30 days and 6 months no significant difference between the groups was found  More studies are required determine if certain patients may benefit from ECPR References Belohlavek J, Smalcova J, Rob D, et al. Effect of Intra-arrest Transport, Extracorporeal Cardiopulmonary Resuscitation, and Immediate Invasive Assessment and Treatment on Functional Neurologic Outcome in Refractory Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA. 2022;327(8):737-747. doi:10.1001/jama.2022.1025   Suverein MM, Delnoij TSR, Lorusso R, et al. Early Extracorporeal CPR for Refractory Out-of-Hospital Cardiac Arrest. N Engl J Med. 2023;388(4):299-309. doi:10.1056/NEJMoa2204511   Summarized by Kirsten Hughes, MS4 | Edited by John Spartz, MD, & Erik Verzemnieks, MD   The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account.

In this episode of the podcast, we sit down with Dr. Zack Shinar of the EDECMO Podcast, and co-author of "ECPR AND Resuscitative ECMO," the world's first ECMO CPR textbook.Dr. Shinar is a world-renowned expert on ECPR and resuscitative ECMO, and he was gracious enough to share a bit of his time with the FlightCrit community.In this episode Dr. Shinar shares with us:The history of ECPR including results from some of the very first casesHow ECPR is changing the culture of cardiac arrest resuscitation worldwideWhat EMS, and Critical Care Transport Teams, can do to help optimize the delivery of ECPR therapy to eligible patients.and how ECMO therapy can be applied in other peri-arrest settings.Links discussed in this podcast:www.edecmo.orgReanimate ConferenceARREST Trial ECPR AND Resuscitative ECMO textbookSupport the showMedic and RN CE's available over at academy.flightcrit.com

Welcome back to May's papers of the month! First up this month we'll be looking at an RCT focussed on prehospital intra-arrest management and comparing an early move in arrest towards ECMO-CPR and invasive treatment, versus remaining on scene continuing ALS until achieving a ROSC. Does E-CPR hold the promise we are hoping for? Next up we take a look at another RCT on pad placement for electrical Cardioversion-BMI of AF, are antero-posterior pads superior to the standard antero-lateral position? Finally we look at the potential for remote supervision of pre-hospital ultrasound, has technology moved the bar in what can be achieved? Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Simon & Rob

Welcome back to March '22 Papers Podcast! This month we have a think about causes and coping strategies for Emergency Clinicians involved in stressful cases; what can trigger us and more importantly what can we do to mitigate these circumstances? In our other two papers we have a think about ECMO-CPR and Resuscitative Thoracotomy, both relatively low frequency but high skill interventions. The papers look at outcomes and case selction and can give us more information about service setups and challenges, and also offer us an opportunityt to mentally mode how we can best prepare and decision make in these cases. Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Simon & Rob

ECMO CPR ECMO in Cardiac arrest has increased exponentially in the past 10 years, on the back of, up until very recently, non-randomised, predominantly retrospective studies. What is the efficacy? Appropriate patient selection? Cost effectiveness and model of delivery of ECPR? Finally is ECMO really the intervention or just optimising the chain of survival? For more head to: codachange.org/podcasts

Bereits vor Jahrzehnten in der Intensivmedizin geboren ist das Verfahren der extrakorporalen Membranoxierung (ECMO) heute weltweit im Einsatz: vereinzelt sogar im bodengebundenen Rettungsdienst. Und Immer mehr Studien rund um den Planeten liefern hinsichtlich Outcome zum Teil bemerkenswerte Ergebnisse, die gerade innerhalb der Reanimationsmedizin aufhorchen lassen und nicht zuletzt deshalb auch ihren Niederschlag im großen ERC-Guideline Update von 2021 gefunden haben.3 Schocks and Go: ist die ECMO-CPR ein Konzept mit Zukunft? Wie läuft das Management im Bereich der Schnittstelle zur Notaufnahme ab? Und welchem PatientInnen-Kollektiv sollen wir unter Reanimation die Option an die ECMO zu kommen ermöglichen?  Gute Unterhaltung!

Theme: Bonus Episode. Participants: Dr Pramod Chandru, Kit Rowe, Shreyas Iyer, Caroline Tyers and, Samoda Wilegoda Mudalige. Discussion 1:Chandru, P., Priyambada Mitra, T., Dutt Dhanekula, N., Dennis, M., Eslick, A., Kruit, N., & Coggins, A. Out of hospital cardiac arrest in Western Sydney: an analysis of outcomes and estimation of future eCPR eligibility - not yet available online. Take-Home Points: This paper was a prospective observational study of consecutive out-of-hospital of cardiac arrests (OOHCAs) at Westmead Hospital over a 3-year period. It looked at the feasibility of setting up an ECMO service for refractory OOHCAs (i.e. for patients who have received CPR for 20 minutes or longer, between the ages of 18 and 70 years, and had a VF arrest). This study had 17 patients who would have qualified as true refractory OOHCAs (none of whom survived to hospital discharge).   This proportion of patients was similar to other studies that have been undertaken on this topic, which also demonstrated a survival to hospital discharge with good neurological recovery of around 35-40% with the use of ECMO CPR.  The 2CHEER study performed out of Melbourne is also a good reference for this subject - this was one of the first RCTs for the use of ECMO CPR in a pre-hospital setting (see reference below). Westmead Hospital will be one of the centers involved in the upcoming RESET trial looking at the implementation of ECMO CPR.   Discussion 2:Bima, P., Pivetta, E., Nazerian, P., Toyofuku, M., Gorla, R., & Bossone, E. et al. (2020). Systematic Review of Aortic Dissection Detection Risk Score Plus D‐dimer for Diagnostic Rule‐out of Suspected Acute Aortic Syndromes. Academic Emergency Medicine, 27(10), 1013-1027. https://doi.org/10.1111/acem.13969. Take-Home Points: This meta-analysis suggested a sensitivity of 97.6-99.9% for an aortic dissection risk score of 0-1 and a negative D-dimer (

In this podcast Dr. Demetri Yannopoulos, a interventional cardiologist with M Health Fairview and Interventional Cardiology Researcher Director with the University of Minnesota-Twin Cities, discusses ECPR (ECMO Cardiopulmonary Resuscitation), the recent Arrest Trial and the Mobile ECMO program. Enjoy the podcast! Objectives:     Upon completion of this podcast, participants should be able to: Define the importance of time and quality of CPR on outcomes from out-of-hospital cardiac arrest (OHCA). Explain the role of ECPR and ECMO teams in the management of out-of-hospital cardiac arrest (OHCA) refractory cardiac arrest. Review the current state of the art management of cardiac arrest and the reorganization of EMS/hospital response to out-of-hospital cardiac arrest (OHCA). CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks.  You may contact the accredited provider with questions regarding this program at  rmccredentialing@ridgeviewmedical.org. Click on the following link for your CME credit: CME Evaluation: "ECPR (ECMO CPR): The Cardiac Resuscitation Frontier with Dr. Demetri Yannopoulos (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for Continuing Education (CE) and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview and Ridgeview Clinics.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on this presentation. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. Demetri Yannopoulos, MD has received honoraria from Helmsley Charitable Trust and the National Institute of Health (NIH) within the past 24 months, as a grant for research studies. Upon an independent review of his presentation, confirms he is following ACCME guidelines, and there is no commercial tie to the named agencies and no impact on his podcast presentation. Ridgeview's Continuing Education Committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. SHOW NOTES: Chapter 1: CPR was introduced in the 1960s. At the time, research at John Hopkins was being conducted on pigs in ventricular fibrillation and ventricular tachycardia who required defibrillation.  It was noted that when pushing defibrillation paddles against the chest wall, the arterial pressure of the subjects increased. It was concluded that with compression, pulsatile flow was generated. This was essentially the first iteration of closed chest CPR. Over the next 50 years or so, clinicians have been looking for better ways to improve survival outcomes. Key factors include early identification, early CPR, along with obtaining resources and assistance to improve ventilation, perfusion, and defibrillation. Poor predictors of survival for cardiac arrest include CPR for greater than 30 minutes and individuals with coronary artery blockage. With the integration of ECMO, it was found that by bypassing the heart and lungs and essentially taking on their functions, outcomes improved. Dr. Yannopoulos reiterates that CPR for greater than 30 minutes results in poor outcomes, thereby creating a goal to both normalize pressures during this time while also fixing the offending cause, such as a coronary artery occlusion.  Around 2015, in the Minnesota metro area, visionary EMS directors implemented an alternative option: If a patient fails three shocks, with ongoing CPR, the patient was transferred to a tertiary care facility with ECMO cannulation capabilities. Once on ECMO, these patients were transferred to the University of MN where they underwent PCI to evaluate for reversible causes such as occluded coronary vessels, PE, etc. Outcomes of this therapy showed 30-40% patient survival, which is a game changing result, thus the need for a randomized control trial, the ARREST Trial. Chapter 2: The ARREST Trial studied a group of patients with out-of-hospital cardiac arrest (OHCA) in ventricular fibrillation, refractory to defibrillation and initial ACLS treatment. This was a randomized control trial where one group was randomized to an ECMO intervention arm, versus a standard ACLS therapy arm. It was a phase 2, single center, open-label, adaptive, safety and efficacy randomized clinical trial.  Specific subject criteria included adults aged 18-75 with OHCA, refractory ventricular fibrillation, with no return of spontaneous circulation (ROSC) after three shocks, with an automated cardiopulmonary resuscitation device or LUCAS device and estimated transfer time shorter than 30 minutes. The primary outcome of the trial was survival to hospital discharge. Secondary outcomes included safety, survival and functional assessment at hospital discharge, at 3 months and 6 months after discharge. Results of the ACLS arm showed a 7% survivability, and zero at both three and six months, while the ECMO arm fared better with a 43% survivability. After enrolling 30 patients, the study was terminated at the first pre-planned interim analysis by the National Heart, Lung and Blood Institute after a unanimous recommendation from the Data Safety Monitoring Board, because the posterior probability of ECMO superiority exceeded the prespecified monitoring boundary. Cumulative 6-month survival was significantly better in the early ECMO group compared to the standard ACLS group. No unanticipated serious adverse events were observed. Conclusion: early ECMO-facilitated resuscitation for patients with OHCA and refractory ventricular fibrillation, significantly improved survival to hospital discharge compared with standard ACLS treatment. Chapter 3:  The Minnesota Mobile Resuscitation Consortium or MMRC, which was the first program to serve an entire metropolitan area in order to rapidly deliver extracorporeal membrane oxygenation (ECMO)-facilitated resuscitation to patients with refractory ventricular fibrillation/ventricular tachycardia (VF/VT) out-of-hospital cardiac arrest (OHCA). This was an observational cohort study that analyzed consecutive patients prospectively enrolled in the MMRC's ECMO-facilitated resuscitation program. Entry criteria were identical to the ARREST Trial, adults 18-75 with an out-of-hospital cardiac arrest in VF or CT with no return of spontaneous circulation post 3 shocks, use of a LUCAS or automated cardiopulmonary resuscitation device, and an estimated transfer time of less 30 minutes. The primary endpoint was functionally favorable survival to hospital discharge with Cerebral Performance Category (CPC) 1 or 2. CPC 1 results in good cerebral performance: conscious, alert, able to work, that might have some mild neuro or psych deficits. CPC 2 results in moderate cerebral disability; conscious, sufficient cerebral function for independent activities of daily living (ADLS). Secondary endpoints included 3-month functionally favorable survival. Between the period of December 1, 2019 and April 1, 2020, 63 consecutive patients were transported, and of these 58 were treated by the mobile ECMO service. Post EMCO treatment 25 of the 58 or 43% were both discharged from the hospital and alive at 3 months with CPC 1 or 2. This first, community-wide ECMO-facilitated resuscitation program in the US demonstrated 100% successful cannulation, 43% functionally favorable survival rates at hospital discharge and 3 months. Chapter 4:  As the research continues, reaching 25-30% positive outcomes would be adequate to start a viable program. Dr. Yannopoulos speculates that with overall system improvement and refined protocols, that number can be as high as 70-80%, which is an incredible number. The future of ECPR will require a combined effort of the healthcare systems, policy makers, administrators, and communities. With a successful program in the urban and suburban areas, future research can hopefully expand access to more rural populations. Dr. Yannopoulos emphasizes that this is not a hospitalized based program, it relies on the EMS system, and those providers, especially medics, are key to the success of the program. At the time of this interview, the mobile ECMO program was on hold due to COVID, but currently the mobile ECMO program has a pending restart date of March 1st. Thanks for listening.

Our ECPR is different...

I will consider this question in two parts;   Should ECMO be considered for all patients?  Should ECMO services be provided in all ICUs?    From a patient perspective, ECMO is a highly invasive intervention and like every other intervention that we consider, the benefits it provides must outweigh its risks for it to be worthwhile.   Clearly, veno-venous and veno-arterial ECMO supports are very different beasts – the patient profile, physiology, complications and outcomes differ considerably. At the extreme of the VA-ECMO spectrum is ECMO-CPR (e-CPR).  Whilst ECMO centres nationally and internationally have published indications and contraindications (which will be discussed), to make decisions around an individual case it is helpful to understand the burden that ECMO support imposes.   For patients this is the physiological burden of being placed on ECMO. This includes frequently the need for ongoing sedation and lack of mobility, the non-physiological cardiorespiratory effects conferred by ECMO, the complications at insertion and during support that patients are exposed to and the uncertain long-term outcomes. These will be discussed further.  The next question is whether all ICUs should be providing this service. The demand for this technology appears to be growing steadily, as is the expectation by other specialties within the hospital for an in-house ECMO service.   Again considering burdens imposed, housing an ECMO programme impacts workload and flow by utilising significant bed-days at the expense of other services that need to be provided, education and credentialing requirements for staff and a financial cost for these resource-intensive patients. These will be discussed individually.  Lastly, the patient outcome implications of centre volume for this highly specialised service will be debated. 

Associate Professor Vincent Pellegrino is a Senior Intensive Care Specialist at The Alfred Hospital and head of the ECMO Clinical Service.  He has had a lead role in the development of ECMO services at The Alfred since 2003. From the ECMO CPR ICN Victoria meeting he discusses how to get patient selection and outcomes right for eCPR.

Peter McCanny is part of the LearnECMO team. In this podcast he explains some of the background and history of ECMO CPR, what evidence there is to support its use and where we're heading in the future.

A demonstration in the ECMO-CPR process and then going back to basics, to understand the need for such a process and how to design and develop it from scratch using simulation to cut lead time and highlight and remove issues prior to rolling out on the patients. Making E-CPR both possible and safer.

Jason Maclure is deputy director of Intensive Care at the Alfred Melbourne. He has strong interests in analgesia and sedation, respiratory failure, ventilation, HFOV and ECMO. From an ICN Victoria 2016 meeting on ECMO CPR he discusses the development of the eCPR protocol at the Alfred.

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. The post EDECMO 26 – “ECPR is a Step Too Far” – Ho vs. Bellezzo: a SMACCback Chicago Cage Match appeared first on ED ECMO.

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. Chris and Joe are the director and vice-director respectively, of Emergency Medicine at Sharp Memorial Hospital in San Diego, California. They are two of the leading experts in ECPR, with Joe being one of the key players behind EDECMO. On a day-to-day basis, they are friends and colleagues, working together in one of the very few centers around the world to deliver ECPR. However in this Cage Match, friends become foe and there are no limitations to how far each will go to prove their side of the debate. On the AFFIRMATIVE side, Chris Ho delivers a convincing argument for why ECPR IS a step too far. From lack of evidence to the cost of “re-animating the dead” and everything in between, Chris Ho delivers a practical approach to the argument and demonstrates without a doubt why we are not ready for this to be the next step in resuscitation. On the NEGATIVE side, Joe Bellezzo delivers an outstanding rebuttal to “Dr Ho’s Nutty Brown Bullshit”. In an inspiring argument filled with anecdotes and occasional facts, Joe Bellezzo makes it impossible to think the ECPR shouldn’t be the next step in our ALS algorithm. Despite strong arguments from either side, as in all debates, there must be a winner. Do you agree with the outcome? If you want to find out whether Chris and Joe were able to kiss and make up, check out the exclusive ICN interview with the two, where they discuss more on ECPR.

Steve Bernard speaks at a meeting on 4/2/14 in Sydney on the reality of ECMO CPR at The Alfred in Melbourne, Victoria, and the upcoming CHEER study. Exciting times!