Podcast appearances and mentions of ed ecmo

Dr. Suraj Yalamuri, Mayo Clinic Anesthesiology Critical Care and Cardiovascular Medicine Consultant, joins Alex and Finch to talk about the fundamentals of ECMO and ECPR. This is a great way to get caught up on this emerging science so that you'll be ready to provide the best resuscitative care for your patients when your system is ready too. 

In this episode Jon Marinaro joins the ED ECMO team and interviews his colleague Sundeep Guliani, MD about the use of an ECMO first strategy for Massive Pulmonary Embolism. Jon and Sundeep review the data and processes from their institution and from other institutions in the United States.  Could it be that ECLS could move the survival needle on this high mortality disease? Listen and find out! Hobohm L, Sagoschen I, Habertheuer A, Barco S, Valerio L, Wild J, Schmidt FP, Gori T, Münzel T, Konstantinides S, Keller K. Clinical use and outcome of extracorporeal membrane oxygenation in patients with pulmonary embolism. Resuscitation. 2022 Jan;170:285-292. doi: 10.1016/j.resuscitation.2021.10.007. Epub 2021 Oct 12. PMID: 34653550. Shinar Z, Hutin A. Pulmonary ECMO-ism: Let's add PEA to ECPR indications. Resuscitation. 2022 Jan;170:293-294. doi: 10.1016/j.resuscitation.2021.11.004. Epub 2021 Nov 10. PMID: 34774708. Pudil J, Rob D, Smalcova J, Smid O, Huptych M, Vesela M, Kovarnik T, Belohlavek J. Pulmonary embolism related refractory out-of-hospital cardiac arrest and extracorporeal cardiopulmonary resuscitation: Prague OHCA study post- hoc analysis. Eur Heart J Acute Cardiovasc Care. 2023 May 12:zuad052. doi: 10.1093/ehjacc/zuad052. Epub ahead of print. PMID: 37172033. Karami M, Mandigers L, Miranda DDR, Rietdijk WJR, Binnekade JM, Knijn DCM, Lagrand WK, den Uil CA, Henriques JPS, Vlaar APJ; DUTCH ECLS Study Group. Survival of patients with acute pulmonary embolism treated with venoarterial extracorporeal membrane oxygenation: A systematic review and meta-analysis. J Crit Care. 2021 Aug;64:245-254. doi: 10.1016/j.jcrc.2021.03.006. Epub 2021 Mar 24. PMID: 34049258.

We chat with Scott Weingart of Emcrit about the use of crash VA ECMO for the cardiac arrest patient. Check out the REANIMATE course here! Listen to the ED ECMO podcast on ECPR here Find us on Patreon here! Buy your merch here! Takeaway lessons

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.  Zack Shinar The post 67: Da DO2: Fundamental ECMO Physiology with Sage Whitmore appeared first on ED ECMO.

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. The post 66: Crash VV ECMO appeared first on ED ECMO.

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! The post 65: ECPR Journal Club: Dual Sequential Defibrillation, CT after ECMO, and much, much more appeared first on ED ECMO.

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?" The post 64: Contraindicated??? – Long Live the Aortic Dissection with Garrett Sterling appeared first on ED ECMO.

"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 The post 63: Covid and ECMO – Who do we cannulate? with Jenelle Badulak appeared first on ED ECMO.

Join the Rotor Wash team as we speak with Dr. Darren Braude from UNM about their program to cannulate in the field. Prehospital ECMO (PECMO) is here and real! Dr. Braude discusses the steps involved to reach this point, as well as the obstacles faced when building their PECMO program. All of this hard work resulted in the first prehospital ECMO Cannulation in the USA late last year.  Check out the episodes of ED ECMO with Dr. Braude: https://podcasts.apple.com/us/podcast/ed-ecmo/id675769252?i=1000451819848 https://podcasts.apple.com/us/podcast/ed-ecmo/id675769252?i=1000455954948 Thanks for listening. We will see you on the sunny beaches of Florida in May, for ECHO Yacht Club 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! The post 62: Jason Bartos Take 2: The Future of ECPR Now appeared first on ED ECMO.

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. The post 61: Jason Bartos – ECPR Redefined appeared first on ED ECMO.

Today's episode focuses on the differences between ECMO physiology in the patient in cardiogenic shock versus the one in cardiac arrest. The post 60: ECPR 2.0 with Scott Weingart appeared first on ED ECMO.

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. The post 59: Partial REBOA and US PreHospital ECPR Revisited appeared first on ED ECMO.

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. The post 58: First U.S. Pre-Hospital ECPR Program appeared first on ED ECMO.

Following the success of Episode 6, which discussed the scientific evidence for ECMO in cardiac arrest, we decided to take a deeper look at the implementation of ECMO in the ED. Drs. Felipe Teran and Joseph Tonna discuss the utilization of ECMO for refractory cardiac arrest, the expansion of hospital ECMO programs to the emergency department and implementation of an ECMO program for cardiac arrest. This episode was recorded on location in Salt Lake City, Utah.   Key Reading: Tonna JE et al., “Practice characteristics of Emergency Department extracorporeal cardiopulmonary resuscitation (eCPR) programs in the United States: The current state of the art of Emergency Department extracorporeal membrane oxygenation (ED ECMO).” Resuscitation. 2016 Oct;107:38-46. https://www.ncbi.nlm.nih.gov/pubmed/27523953 Tonna JE et al., “Development and Implementation of a Comprehensive, Multidisciplinary Emergency Department Extracorporeal Membrane Oxygenation Program.” Ann Emerg Med. 2017 Jul;70(1):32-40. https://www.ncbi.nlm.nih.gov/pubmed/28139304

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. The post 57: The New REBOA catheter – Perfecting the Partial Occlusion appeared first on ED ECMO.

心脏骤停患者的福音： ——建设多科室合作的体外肺膜氧合(ED ECMO)项目可显著提高患者神经有利性生存机率 Despite advances inthe medical and surgical management of cardiovascular disease, greater than350,000 patients experience out-of-hospital cardiac arrest in the United Statesannually, with only a 12% neurologically favorable survival rate. Of these patients,23% have an initial shockable rhythm of ventricular fibrillation/pulselessventricular tachycardia (VF/VT), a marker of high probability of acute coronaryischemia (80%) as the precipitating factor. However, few patients (22%) willexperience return of spontaneous circulation and sufficient hemodynamicstability to undergo cardiac catheterization and revascularization. Previous case series and observationalstudies have demonstrated the successful application of intra-arrestextracorporeal life support, including to out-of-hospital cardiac arrestvictims, with a neurologically favorable survival rate of up to 53%. Forpatients with refractory cardiac arrest, strategies are needed to bridge themfrom out-of-hospital cardiac arrest to the catheterization laboratory andrevascularization. To address this gap, we expanded our ICU and perioperativeextracorporeal membrane oxygenation (ECMO) program to the emergency department(ED) to reach this cohort of patients to improve survival. 尽管人类在心血管疾病的医学和外科治疗上取得了进展，但美国每年仍有超过350000名患者经历了院外心脏骤停，且对神经系统预后有利的存活率只有12%。其中23％的患者具有室颤或者无脉性室性心动过速(VF/VT)的初始可电击心律，这有80%的机率诱发急性冠状动脉缺血，因此可作为其发病的标志。 然而，很少有患者（22％）会经历自主循环恢复以及拥有足够的血液动力学稳定性来进行心脏导管术和血运重建。过往病例分析和观察性研究已经证明内骤停后成功应用体外生命支持的患者，包括院外心脏骤停患者，可以将对神经系统预后有利生存率提高到53％。 对于难治性心脏骤停患者，需要采取的策略是将他们从院外心脏骤停与导管室以及血运重建连接起来。为了缩小这一差距，该研究团队提倡将ICU和围术期应用体外膜肺氧合（ECMO）的项目扩展到急诊科（ED），以期提高患者的生存率。 A primary goal of this program was thedevelopment of a multidisciplinary system to coordinate patient care acrossmultiple silos within our medical system, ranging from emergency medicalservices (EMS), emergency department (ED), cardiac catheterization laboratory,cardiothoracic surgery, and ICU. The author strongly believes thatmultidisciplinary support is essential for good outcomes, and the team observedthat their multidisciplinary program resulted in a high rate of successfulinitiation of ECMO during cardiac arrest in the ED. This article primallyintroduces the research team's experience of design and implementation of acomprehensive and multidisciplinary program of ED ECMO as a template forinstitutions interested in building their own ED ECMO programs. 该项目的主要目标是开发一个多科室系统，用以协调医疗系统内多个科室的患者护理，包括紧急医疗服务（EMS），急诊科（ED），心导管室，心胸外科和重症监护室（ICU）。 作者认为多学科支持对能否取得良好的治疗效果至关重要,并且发现他们开展的多科室合作项目能提高急诊科对心脏骤停患者实施ECMO的成功率。本文主要介绍作者及其团队开展综合性且多科室合作的ED ECMO流程，以此作为其他机构有意建立ED ECMO项目的实施模板。 The process about ED ECMO program carried outin the University of Utah is showed in the Figure1. The program has evaluationand activation levels with associated page groups. The “EVAL” page is initiatedby the ED charge nurse in conjunction with the ED attending physician; theyreceive base calls from EMS and identify any patients who meet the inclusioncriteria. The EVAL page goes out before patient arrival and includes the cardiothoracicsurgeon on call, the in-house cardiovascular ICU intensivist, theinterventional cardiologist, the cardiovascular ICU charge nurse or ECMO chargenurse, the house supervisor, and the ED echocardiography group. Meanwhile, thepreparation for ED resuscitation room should be completed. 图1展示了作者及其团队在犹他大学开展的ED ECMO项目的流程。该项目具有评估和激活水平的相关页面。“EVAL”页面由ED护士长与ED主治医师共同管理;他们接受来自EMS的调用，并确定符合标准的患者。 EVAL页面在患者到来之前将被发送给待命的心胸外科医生，心血管重症监护室专科医生，心内科医生，心血管重症监护室护士长或者ECMO护士长，医院主管以及ED心脏超声组。同时，应完成ED复苏室的准备工作。 For the process to move from evaluation toactivation, confirmation of the availability of a cardiovascular ICU chargenurse or ECMO charge nurse (both bed and staffing availability),a catheterization laboratory bythe interventional cardiologist, and a cardiothoracic surgeon for initialcannulation should be made. All 3 individuals must agree on the appropriatenessof the patient for ECMO. Once determination of candidate appropriateness ismade, the second-tier activation process activates the catheterizationlaboratory and anesthesia. Then the ECMO for patients start to be performed. 流程由评估阶段进入激活阶段，心血管重症监护室护士长或者ECMO护士长以及床位与人力资源的可用性需要得到确认，导管室的可用性由心脏病介入治疗专家确认，以及负责患者初始穿刺的心胸外科医生可用性需要得到确认。以上3个人必须就患者是否适合实施ECMO达成一致。 一旦确定候选人符合要求，第二层激活程序激活导管室和麻醉室。然后对患者实施ECMO治疗。 Once flow is adequate, vasopressors andinotropes are adjusted and the patient is transported to the catheterizationlaboratory for angiography, assessment of left ventricular function withdecompression (as needed), and establishment of distal limb perfusion. 一旦患者血流量充足，调整血管加压剂和强心剂的使用量，并将患者转移到导管室进行血管造影，通过减压（根据需要）评估左心室功能，并建立远端肢体灌注。 On arrival in the cardiovascular ICU,patients are managed at the bedside by an ECMO-trained charge nurse, withdirection from the ICU intensivist and cardiothoracic surgeon. We attempt towean ECMO during 3 to 7 days, or as rapidly as possible, to achieve an“ECMO-free” assessment of patients' postarrest cardiac and neurologic function.Neurology and neurocritical care consultants provide neuroprognostication,which, for patients not waking up spontaneously. 患者转到心血管重症监护室后，由接受培训的ECMO护士长在重症监护室特护医生和心胸外科医生指导下进行临床护理。我们尽可能快地在3至7天内停止ECMO治疗，以实现对患者心脏和神经功能的“无ECMO”评估。对于不自发醒来的患者,神经病学和神经临床护理顾问提供神经损伤的评估。 The value of an ED ECMO program lies in theability to temporally bridge the patient with adequate organ perfusion to atherapeutic intervention, such as percutaneous coronary intervention. Without aclear therapeutic goal and interventions to achieve it, the application of EDECMO adds only cost and prolongation of the end of life. Conversely, theappropriate measured application of ED ECMO to select victims ofout-of-hospital cardiac arrest in conjunction with practiced efforts to reversethe inciting cause of arrest may offer one of greatest possible increases insurvival of any bundled medical therapy. ED ECMO项目的价值在于能够通过适当的器官灌注暂时性地将患者桥接到干预性治疗，如冠脉介入治疗。如果没有明确的治疗目标和干预措施，ED ECMO的应用只是增加了成本和推迟患者死亡的期限。相反，采用合适的标准选择院外心脏骤停患者进行 ED ECMO 治疗，再辅以熟练的技巧可以逆转造成心脏骤停的病因，从而有可能得到医药配合治疗下最大的生存率提高。 Annals of EmergencyMedicine: Development and Implementation of a Comprehensive, MultidisciplinaryEmergency Department Extracorporeal Membrane Oxygenation Program. 想收听更多医学前沿咨询，欢迎下载医阶APP，不仅有顶尖医师的临床分享，还有行业大咖的病例解析。

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. The post 56: Pressors, Fluid, or Flow – Optimizing ECMO Physiology appeared first on ED ECMO.

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. The post 55 – Anticoagulation of the ECMO Patient with Troy Seelhammer appeared first on ED ECMO.

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. The post 54: Confirmation of Wire Placement with Sacha Richardson appeared first on ED ECMO.

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. The post 53b: Resuscitationist Inserted Distal Perfusion Catheter with Chris Couch appeared first on ED ECMO.

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. The post 53: Distal Perfusion Catheter with Joe Dubose appeared first on ED ECMO.

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! The post 52: Brain Freeze- Selective Retrograde Cerebral Perfusion for Intra-Arrest Neuroprotection appeared first on ED ECMO.

 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. The post 51 – Proximal Balloon Occlusion for Cardiac Arrest appeared first on ED ECMO.

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! The post 50b Inter-Facility Transport of ECMO patients Part 2 of 2 appeared first on ED ECMO.

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. The post 50a Inter-facility Transport of ECMO patients Part 1 of 2 appeared first on ED ECMO.

Author: Dylan Luyten, MD Educational Pearls:   Extracorporeal membrane oxygenation (ECMO) is similar to bypass ECMO is being utilized routinely at some centers and even prehospital in cardiac arrest There are two general types of ECMO: Venovenous (VV-ECMO) is useful when the patient cannot oxygenate but has adequate heart function. Venoarterial (VA-ECMO) is more like typical bypass and can be used in a pulseless patient   References: Ouweneel DM, Schotborgh JV, Limpens J, Sjauw KD, Engström AE, Lagrand WK, Cherpanath TGV, Driessen AHG, de Mol BAJM, Henriques JPS. Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis. Intensive Care Med. 2016 Dec;42(12):1922-1934. doi: 10.1007/s00134-016-4536-8. Epub 2016 Sep 19. Review. PubMed PMID: 27647331; PubMed Central PMCID: PMC5106498. Tonna JE, Johnson NJ, Greenwood J, Gaieski DF, Shinar Z, Bellezo JM, Becker L, Shah AP, Youngquist ST, Mallin MP, Fair JF 3rd, Gunnerson KJ, Weng C, McKellar S; Extracorporeal REsuscitation ConsorTium (ERECT) Research Group.. Practice characteristics of Emergency Department extracorporeal cardiopulmonary resuscitation (eCPR) programs in the United States: The current state of the art of Emergency Department extracorporeal membrane oxygenation (ED ECMO). Resuscitation. 2016 Oct;107:38-46. doi: 10.1016/j.resuscitation.2016.07.237. Epub 2016 Aug 11. PubMed PMID: 27523953; PubMed Central PMCID: PMC5475402.   Summary by Travis Barlock, MS4  | Edited by Erik Verzemnieks, MD

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. The post 49 – You Can’t Spell REBOA without the ER – Endovascular Resuscitation of the Trauma Patient – Zaf Qasim appeared first on ED ECMO.

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. The post EDECMO 48: When Should I Transport a Cardiac Arrest? appeared first on ED ECMO.

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. The post EDECMO 47: ECMO Donazione: Organ Transplantation with Velia Antonini appeared first on ED ECMO.

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. The post EDECMO 46: Wire Assistant appeared first on ED ECMO.

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? The post EDECMO 45: ECMO in Sepsis appeared first on ED ECMO.

Yanno on ECPR The post EDECMO Crash Episode – Demetris Yannopoulos on ECPR-the Minneapolis Way appeared first on ED ECMO.

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.   The post EDECMO 44: Bob Bartlett: Peristaltic Pumps, Hollow Fibers, and the History of ECMO appeared first on ED ECMO.

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. The post EDECMO 43: The Cutdown appeared first on ED ECMO.

I’m just a Reanimatologist - Episode 3 This month’s episode explores the controversial topic of Emergency Department initiated extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS). Dr. Jonathon Ford relives a challenging case of beta blocker and calcium channel blocker overdose. Then, we have a front row seat in the heated battle of words between Dr. John Rose and Dr. Dan Colby on the pros and cons of ED ECMO. Where do you stand? Join the conversation on Social Media @empulsepodcast or at https://ucdavisem.com Hosts: Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis Dr. Julia Magaña, Assistant Professor of Emergency Medicine at UC Davis – Pediatric Emergency Medicine Guests: Dr. Jonathon Ford, Assistant Professor of Emergency Medicine, and Medical Toxicologist at UC Davis Health Dr. Dan Colby, Assistant Professor of Emergency Medicine, and Medical Toxicologist at UC Davis Health Dr. John Rose, Professor of Emergency Medicine at UC Davis Health, and EMS Medical Director for Yolo County Resources: Massive diltiazem and metoprolol overdose rescued with extracorporeal life support https://www.ncbi.nlm.nih.gov/pubmed/28705745 Chenoweth JA, Colby DK, Sutter ME, Radke JB, Ford JB, Nilas Young J, Richards JR. Am J Emerg Med. 2017 Oct;35(10):1581.e3-1581.e5. doi: 10.1016/j.ajem.2017.07.023. Epub 2017 Jul 6. PubMed PMID: 28705745. The ED ECMO Project and Podcast with Doctors Joe Bellezzo, Zack Shinar, and Scott Weingart. http://edecmo.org ECLS Registry Report on http://elso.org Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

Life after death—right here on earth—is now a reality for a growing number of patients who were once technically declared dead. As a world-renowned expert in resuscitation science and an Emergency Room physician at Sharp Memorial Hospital in San Diego, Dr. Zack Shinar is a hands-on practitioner of ECMO, or Extracorporeal Membrane Oxygenation, a life support procedure that involves pumping one’s blood outside the body. Zack walks us through his first encounters cheating death with ECMO and how it has become a regular work day for him to do so. Find out how he’s influencing the worldwide medical community and creating unique educational experiences to expand the impact of resuscitation science from his podcast ED ECMO to an annual conference he co-founded called Reanimate. We discuss future skills like interdisciplinary curiosity, statistical literacy, and effective decision-making for both doctors and patients. Hear how attending one of Zack’s Reanimate Conferences gave one man the skills to bring his own son back to life. For more information about the podcast and this week's show notes, visit www.aheadofourtime.com/raise-the-dead.

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 […] The post EDECMO 42: Organ Transplantation On ECMO appeared first on ED ECMO.

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. The post EDECMO 41 – The 3 Stages of ECPR – Diane’s Story appeared first on ED ECMO.

  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 […] The post EDECMO 40: EROCA – The trial that asks “Should ER Docs Initiate ECPR?” appeared first on ED ECMO.

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. The post EDECMO 39: Who Do We Put On ECMO? – New Data on Prognostics appeared first on ED ECMO.

Comfortable with G-tubes, tracheostomies, and VP shunts? Good.  Get ready for the next level: Vagus Nerve Stimulators, Intrathecal Pumps, and Ventricular Assist Devices.   Details in Audio: Vagus Nerve Stimulators For intractable epilepsy; sends retrograde signal up corona radiata Also may be used in: depression, bulimia, Alzheimer, narcolepsy, addiction, and others VNS magnets Are VNS safe in MRI? Are VNS safe in everyday life? Intrathecal Pumps Used to infuse basal rate of drug, usually baclofen for spasticity, but pump may contain morphine, bupivicaine, clonidine.  Also used for severe MS, stroke, TBI, chronic pain.  Verify the medication and identify the toxidrome if symptomatic. Ventricular Assist Devices May be left ventricular assist, right ventricular assist, or biventricular assist device.   References Vagus Nerve Stimulators (VNS) Elliott RE, Rodgers SD, Bassani L et al. Vagus nerve stimulation for children with treatment-resistant epilepsy: a consecutive series of 141 cases. J Neurosurg Pediatrics. 2011; 7:491-500. Groves DA, Brown VJ. Vagal nerve stimulation: a review of its applications and potential mechanisms that mediate its clinical effects. Neuroscience and Biobehavioral Reviews. 2005; 29: 493–500. Panebianco M, Rigby A,Weston J,Marson AG. Vagus nerve stimulation for partial seizures. Cochrane Database of Systematic Reviews. 2015; 4, Art. No.: CD002896. Ruffoli R,  Giorgi FS, Pizzanelli C et al. The chemical neuroanatomy of vagus nerve stimulation. Journal of Chemical Neuroanatomy; 2011; 42: 288–296. Intrathecal Pumps Borowski A, Littleton AG, Borkhuu B et al. Complications of Intrathecal Baclofen Pump Therapy in Pediatric Patients. J Pediatr Orthop. 2010; 30:76–81. Ghosh D, Mainali G, Khera J, Luciano M.  Complications of Intrathecal Baclofen Pumps in Children: Experience from a Tertiary Care Center. Pediatr Neurosurg. 2013; 49:138–144. Yang TF, Wang JC, Chiu JW et al. Ultrasound-guided refilling of an intrathecal baclofen pump—a case report. Childs Nerv Syst. 2013; 29:347–349. Yeh RN, Nypaver MM, Deegan TJ, Ayyangar R. Baclofen Toxicity in an 8-year-old with an Intrathecal Baclofen Pump. J Emerg Med. 2004; 26(4): 163–167. Ventricular Assist Devices Blume ED, Naftel DC, Bastardi HJ et al. for the Pediatric Heart Transplant Study Investigators. Outcomes of Children Bridged to Heart Transplantation With Ventricular Assist Devices: A Multi-Institutional Study. Circulation. 2006; 113: 2313-2319. Colón JE, Laborde ME, Nossaman BD. Case Report: Left Ventricular Assist Device in a 12 Year Old Child as a Bridge to Heart Transplantation. Section of Congenital Cardiac Anesthesia, Ochsner Medical Center, New Orleans, Louisiana. 2012. Fan Y, Weng YG, Huebler M et al. Predictors of In-Hospital Mortality in Children After Long-Term Ventricular Assist Device Insertion. J Amer Coll Cardiol. 2011; 58(11):1183–90 Fraser CD,  Jaquiss RDB, Rosenthal DN et al. Prospective Trial of a Pediatric Ventricular Assist Device. N Engl J Med. 2012;367:532-41. Gazit AZ, Gandhi SK, Canter CC. Mechanical Circulatory Support of the Critically Ill Child Awaiting Heart Transplantation. Current Cardiology Reviews. 2010; 6: 46-53. VanderPluym CJ, Fynn-Thompson F, Blume ED.  Ventricular Assist Devices in Children Progress With an Orphan Device Application. Circulation. 2014;129:1530-1537. This post and podcast are dedicated to Joe Bellezzo, MD, FACEP and Zack Shinar, MD, FACEP for bringing us all up to speed.  Listen to their fantastic ED ECMO podcast here.

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! The post Crash Episode: Iowa OHCA ECMO Save – with Andrew Karl Terry appeared first on ED ECMO.

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. The post EDECMO 38 – ECMO and Trauma – with Pal Ager-Wick and Magnus Larsson appeared first on ED ECMO.

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. The post EDECMO 37 – Nate’s Story appeared first on ED ECMO.

The University of Minnesota Cath Lab Cannulation Method The post Crash Episode – MicroDissection of Yannopoulos’ ECMO Method appeared first on ED ECMO.

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! The post EDECMO 36 – Crushing the Nihilism of Cardiac Arrest – with Demetris Yannopoulos appeared first on ED ECMO.

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: The post EDECMO 35 – REBOA REVISITED! appeared first on ED ECMO.

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!! The post EDECMO 34 – The Day After REANIMATE – with Dr. Sean Deitch appeared first on ED ECMO.

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. The post EDECMO 33a – “Bringing Down the House” by Zack Shinar (from RESUSfest 2016) appeared first on ED ECMO.

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. The post EDECMO 32 – Archimedes Screw: Is Impella the Future of Mechanical Circulatory Support? appeared first on ED ECMO.

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. The post EDECMO 31 – Anaphylaxis & Epi-Pens. Are we ready for VV-ECMO in the Emergency Department? appeared first on ED ECMO.

Post Pump Crit Care The post EDECMO 30 – Post-Arrest ECMO Critical Care Management with Deirdre Murphy appeared first on ED ECMO.

Joe interviews Torvind Naesheim, an intensivist and cardiothoracic anesthesiologist from Norway, on the management of accidental hypothermic arrest using ECMO The post EDECMO 29 – ECMO in Hypothermic Cardiac Arrest – with Torvind Naesheim of Norway appeared first on ED ECMO.

Zack talks with the ED ECMO team from the University of Utah about how they established their ECPR program. The post EDECMO 28 – The University of Utah EDECMO Experience and the ERECT Collaborative appeared first on ED ECMO.

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. The post EDECMO 27 – A Real-World Case of a Crashing Multi-Drug OD Patient Saved with ED ECMO appeared first on ED ECMO.

Poisons and novel agents are a moving target in the clinical arena. This talk begins with a historical look at decontamination and pitfalls that have been discovered along the way. The advent of intubation and critical care was a major boon in the improvement in mortality from poisoning. The Scandinavian Method is described and is an important lesion to this day. The rise of antidotes is mentioned.   Emerging drugs are highlighted in the context of where we have come from. The phenylethylamine compound structure and corresponding variants are described. The importance of the principles of supportive care as learned in the Scandinavian method is emphasized. Other emerging topics including synthetic cannabinoids, and anti-NMDA receptor antagonists are discussed. Emerging interventions of prescription naloxone, and ED ECMO are outlined. High vigilance for new agents, and innovative treatments will enable clinicians deal with these evolving trends.

ECMO or extracorporeal membrane oxygenation has shown promise in the use of cardiac arrest patients. Zack Shinar and his crew from San Diego have lead the way in emergency physician initiated ECMO for patients in cardiac arrest. In this lecture he explains briefly how ECMO works, what their outcomes have been and where ECMO is moving. Initially 5 of their first 8 patients were neurologically intact survivors. Their first patient had over an hour of downtime when cardiac bypass was initiated. He walked out of the hospital completely neurologically intact nine days later and now has been featured on the film “Code Black”. Physicians from their hospital, Sharp Memorial, were also recently featured on the television show “Untold Stories in the ER” for a save of a 21 year old female arresting from hyperkalemia. Dr. Shinar also discusses some of the latest physiologic questions as the Australians have pushed for smaller diameter catheters that allow for smaller flow volumes. He also discusses how in Paris pre-hospital ECMO is being done by physicians in various places like the subway, apartment buildings and even the Louvre. In the end, Dr. Shinar discusses the biggest question in any novel resuscitation technique: cost. Prolongation of life and particularly after a cardiac arrest is expensive and many people do not survive. Dr. Shinar uses various pioneers in the world of technology to tell how true genius is not in technologic advancements but in making those advancements available to the masses. He ends with a story about Linus Torvalds. Dr. Shinar shows how this man through the use of the collective minds of computer programmers worldwide created one of the best operating systems ever created: Linux. He asks the medical community to endorse this idea and introduces the concept of “free open access medical innovation”.

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.

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." The post EDECMO 25.5 – (Part 2) an EDECMO short with Jim Manning – on location with the SAMU pre-hospital ECMO team in France appeared first on ED ECMO.

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 post EDECMO 25 – ‘Ze ECMO TEAM.’ Manning and Lamhaut: Updates on ECMO, the new 7F REBOA Catheter, and Pre-hospital ECMO in France appeared first on ED ECMO.

The Rat Pack: The Last Year of EDECMO! The post The Rat Pack: Another Year of EDECMO (2014/2015) – Video appeared first on ED ECMO.

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... The post EDECMO 24 – Weaning VA-ECMO, with Deirdre Murphy appeared first on ED ECMO.

SMACC BACK!  In the third interview of the series, Sophie and myself get the opportunity to discuss all things ECMO with leading experts of ED ECMO, Joe Bellezzo and Chris Ho.  Following their highly entertaining cage match at SMACC Chicago in which Joe and Chris are forced to take opposing sides on ED ECMO, we get to hear their real opinions on how this equipment is becoming more and more accessible and valuable in the resus scenario. Between the friendly banter, Joe and Chris have some incredible insights into the future of ECPR.  We hope to see a lot more of these guys at SMACC next year!   

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... The post EDECMO 23 – ORNATO LIVES! – How ECMO Saved a Pillar of Resuscitation appeared first on ED ECMO.

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. The post EDECMO 22 – Managing the Crashing Tox Patient with ECMO – with Leon Gussow & Steve Aks from The Poison Review appeared first on ED ECMO.

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 The post REANIMATE SAN DIEGO 2016: February 25-26, 2016 appeared first on ED ECMO.

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. The post EDECMO 21- The Vienna Project: A Randomized-Controlled Trial of ECPR for Out-Of-Hospital Cardiac Arrest appeared first on ED ECMO.

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. The post EDECMO 20 – The Golden Hour & the Rule of 3’s: Optimizing the Critical First Hour on Heart-Lung Bypass appeared first on ED ECMO.

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! The post ECMO Simulation Model Built by Zack!! appeared first on ED ECMO.

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. The post EDECMO 19 – ECPR for Out-of-Hospital Cardiac Arrest Japanese-Style! appeared first on ED ECMO.

In this episode Zack & Joe talk with Graham Nichol about how to use remote ischemic conditioning to reduce ischemia-reperfusion injury after cardiac arrest. The post EDECMO 18 – Remote Ischemic Conditioning – with Graham Nichol appeared first on ED ECMO.

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. The post EM:RAP Mini – Zack & Joe recap AHA 2014: ‘bleeding edge’ interventions in the ED appeared first on ED ECMO.

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. The post EDECMO 17 – The Reanimateur: Lionel Lamhaut on Pre-Hospital ECPR appeared first on ED ECMO.

Zack & Joe talk with Dr. Cyrus Olsen about the challenges of deciding who does, and who doesn't, get advanced resusctition. The post EDECMO 16: The End-of-Life Matrix & The Ethics of Advanced Resuscitation with Dr. Cyrus P. Olsen III, D.Phil. appeared first on ED ECMO.

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. The post EDECMO 15: The CHEER Trial & Part 2 of our Interview with Dr. Stephen Bernard appeared first on ED ECMO.

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. The post EDECMO Episode #14: ECPR with Stephen Bernard 1/2 appeared first on ED ECMO.

Critical Review of 2 of the big papers on VV-ECMO for ARDS. The post Evid-ECMO 2: Veno-Venous ECMO in ARDS – The CESAR Trial & ANZ-ECMO appeared first on ED ECMO.

The 3 of us discuss all things PEA The post EDECMO # 13 – Does Pseudo-PEA Exist and What Should You Do About It appeared first on ED ECMO.

Zack and Joe and discuss two high-impact articles that compare conventional CPR to ECPR. The post Evid-ECMO (Evidence for ECMO): Critical Analysis of the ECMO literature #1 appeared first on ED ECMO.

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. The post EDECMO Episode 12 – The Nurse-Based ECMO Program at Sharp Memorial Hospital with Suzanne Chillcott RN, BSN appeared first on ED ECMO.

Video Promo for the "Bring Me Back to Life" conference coming up on October 21, 2014 in Montreal! The post Video: “Bring Me Back to Life” Conference in Montreal; October 21, 2014 appeared first on ED ECMO.

Highlights from the Paris ECMO Course The post EDECMO Episode 11 – The Paris ECMO Course appeared first on ED ECMO.

~Based on a listener voicemail message, this episode focuses on the cognitive task analysis of ultrasound during ECPR. The post EDECMO Episode 10 – “Sequencing” – Ultrasound Priorities During ECPR appeared first on ED ECMO.

When your only option is to put the horse before the cart you focus on the basics: like history and physical exam, not ECMO! The post EDECMO Episode 9 – The Antithesis of ECPR: African Ingenuity! appeared first on ED ECMO.

Priming the ECMO Circuit... The post EDECMO Episode 8 – “Prime Time!” – prepping the ECMO circuit for action! appeared first on ED ECMO.

Who should get VV ECMO and when should you take it off The post EDECMO Episode 7 – Dan Herr on Choosing VV Candidates and Weaning appeared first on ED ECMO.

Joe talks with Peter Rosen, one of the Godfathers of Emergency Medicine, on the topic of life & death The post EDECMO Episode 6 – On Life & Death with Peter Rosen appeared first on ED ECMO.

Joe and I discuss in excruciating detail how to execute Stages I and II of ECPR The post Episode 5 – Cognitive Task Analysis of Stages I and II of Extracorporeal CPR appeared first on ED ECMO.

Bernard on CHEER from ICN The post Steven Bernard on the CHEER Trial from Intensive Care Network appeared first on ED ECMO.

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... The post Episode 4 – The Tactical Approach to the Cardiac Arrest appeared first on ED ECMO.

This interview with Joe Bellezzo is what caused Scott to pursue ECLS. The post Resuscitative ECMO Interview from EMCrit.org appeared first on ED ECMO.

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. The post Episode 3 – Who the HELL do we put on ECMO during Arrest? appeared first on ED ECMO.

In this episode, Joe and Zack discuss the three stages of ECPR initiation. The post Episode 2 – The Three Stages of ECPR appeared first on ED ECMO.

In this episode, Joe and Zack discuss some of the terminology and basics of ECMO and ECLS. The post Episode 1 – An Introduction to ECMO Terminology appeared first on ED ECMO.

In this episode you'll hear why we started the EDECMO project and a little bit about what we hope to offer. The post Episode 0 – About the EDECMO Project and the Hosts appeared first on ED ECMO.

Joe Bellezzo, MD along with his partner-in-crime, Zack Shinar, MD have started an ED ECMO service at Sharp Memorial Hospital in San Diego. I am so jealous! In this episode of the podcast, I get to talk to Joe about how it works.