EDECMO 102: ECPR Patient's Brains are Different
EDECMO
We need a major change in the way we think about the brains of ECPR patients. We have been duped into thinking that they are the same as regular resuscitation patients and the answer is that they are not. On EDECMO 102, we get an education on this idea from two wonderful people: Ingrid Magnet and Michael Pope. In addition to the inspirational ECPR program they have created in Vienna, they have published a paper showing just how different these two groups of patients are. They show that ECPR patients improve their neurologic function tremendously over the six...
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EDECMO 101: Head Up CPR with Paul Pepe and Jon Marinaro
EDECMO
How do we improve survival from cardiac arrest? Does Head-Up CPR improve outcomes? Paul Pepe, the premier expert in the field, gives us the data and reasons why heads-up CPR can improve outcomes. Dr. Pepe also discusses estrogen and it's potential to improve resuscitation outcomes.
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Sydney Prehospital ECPR with Nat Kruit
EDECMO
On this 100th episode of EDECMO, Sydney's very own Nat Kruit tells us how they organized a prehospital system. She and her crew have a wonderful job organizing a cadre of new cannulators to now have a functional system that can provide the residents of Sydney the opportunity to benefit from ECPR. Take a listen, she's fantastic.
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EDECMO 99: Bruen - Becoming an Expert Cannulator
EDECMO
EDECMO - Episode 99 is a gem. Charles Bruen tells us how he has become an ECPR cannulator within the prestigious Minnesota Mobile Resuscitation Consortium. He shares pearls about cannulation as well as the next steps for Minnesota's innovative approach to bringing ECPR to largest population that is possible. A couple of pearls from Dr. Bruen's cannulation piece are holding pressure in the groin with the ultrasound probe, understanding that the inguinal fold does not represent the inguinal ligament, inserting the needle at a 45-degree angle, and insertion at the common femoral...
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EDECMO 98: Eddy Fan - VV ECMO - Numbers, Nuance, and the Human Factor
EDECMO
Who Really Gets VV ECMO? Numbers, Nuance, and the Human Factor Is VV ECMO purely a numbers game? Or is there a softer, more human side to deciding who receives this life-saving therapy? In this candid and insightful interview, Jon Marinaro sits down with the legendary Dr. Eddy Fan—one of the most published and respected voices in the field of critical care. Together, they unpack the hard data and the gray areas: prognostic scoring, patient selection, and the ethical dilemmas that come with scarce resources. They also dive into the “sticky” dynamics of ECMO programs, including the subtle...
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97 Training of an ECPR Cannulator Army with Joe Bellezzo
EDECMO
Is it better to rely on a few highly trained specialists—or an army of less experienced proceduralists? In this episode, Joe Bellezzo and Zack delve into the evolution of ECPR (Extracorporeal Cardiopulmonary Resuscitation), exploring the pros and cons of each cannulation model. They examine how different cities face unique challenges and opportunities when implementing ECPR systems. San Diego’s approach, in particular, offers a replicable framework that may work for other urban centers. Joe and Zack break down the specific strategies that helped San Diego develop a successful and...
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96: ECPR in India and China with Pranay Oza and Simon Sin
EDECMO
Zack Shinar interviews Pranay Oza, an intensivist from Mumbai, and Simon Sin, an intensivist from Hong Kong, about the insights, necessities, and opportunities for ECPR in India and China.
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EDECMO 95: ECPR Organ Procurement with Stephen Wall
EDECMO
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94: Blending Revisited with Aidan Burrell
EDECMO
In our last episode, Trina Augustin discussed whether we should use a Blender in ECPR patients citing the Blender Trial. This month we got the first author of the Blender Trial, Aidan Burrell, to give us insight into the use of blenders for not only ECPR patients but VA for cardiogenic shock and VV patients. Jon Marinaro interviews Aidan for this wonderful addition to this complex decision.
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EDECMO 93: Do you Blend? with Trina Augustin
EDECMO
This seems like such a basic question and yet the answer is not an answer at all. Rather it is an educated opinion. Today we ask the question - Should we blend ECPR patients? Here's the basic problem. We think hyperoxemia in critically ill patients is bad (Remember hyperoxemia is high oxygen in blood, hyperoxia is high oxygen in the tissue). We think that hypoxemia in critically ill patients is bad. So if a patient gets put on ECMO and we can make the oxygen level coming out of the machine whatever level we want, what level should we set it at? Well, today, Trina...
info_outlineThis seems like such a basic question and yet the answer is not an answer at all. Rather it is an educated opinion. Today we ask the question - Should we blend ECPR patients?
Here's the basic problem. We think hyperoxemia in critically ill patients is bad (Remember hyperoxemia is high oxygen in blood, hyperoxia is high oxygen in the tissue). We think that hypoxemia in critically ill patients is bad. So if a patient gets put on ECMO and we can make the oxygen level coming out of the machine whatever level we want, what level should we set it at?
Well, today, Trina Augustin teaches how this seemingly simple problem is actually quite complex. Trina is an ECMO superstar. She practices at Mayo in Rochester as CV Intensivist with a background in CC/EM. She teaches the most complex part of Reanimate - post pump critical care and yes she cannulates patients as well. Listen to Zack and Trina banter over this complex topic specifically focusing on the release of the Blender Trial.
EMCRIT ECMO Podcast with Trina that is awesome! - CV-EMCrit - MCS Minute Series: Differential Gas Exchange on Peripheral Femoral VA ECMO with Trina
Bibliography:
Winiszewski H, Guinot PG, Schmidt M, Besch G, Piton G, Perrotti A, Lorusso R, Kimmoun A, Capellier G. Optimizing PO2 during peripheral veno-arterial ECMO: a narrative review. Crit Care. 2022 Jul 26;26(1):226. doi: 10.1186/s13054-022-04102-0. PMID: 35883117; PMCID: PMC9316319.
Bureau C, Schmidt M, Chommeloux J, Rivals I, Similowski T, Hékimian G, Luyt CE, Niérat MC, Dangers L, Dres M, Combes A, Morélot-Panzini C, Demoule A. Increasing Sweep Gas Flow Reduces Respiratory Drive and Dyspnea in Nonintubated Venoarterial Extracorporeal Membrane Oxygenation Patients: A Pilot Study. Anesthesiology. 2024 Jul 1;141(1):87-99. doi: 10.1097/ALN.0000000000004962. PMID: 38436930.
Burrell A, Ng S, Ottosen K, Bailey M, Buscher H, Fraser J, Udy A, Gattas D, Totaro R, Bellomo R, Forrest P, Martin E, Reid L, Ziegenfuss M, Eastwood G, Higgins A, Hodgson C, Litton E, Nair P, Orford N, Pellegrino V, Shekar K, Trapani T, Pilcher D. Blend to Limit OxygEN in ECMO: A RanDomised ControllEd Registry (BLENDER) Trial: Study Protocol and Statistical Analysis Plan. Crit Care Resusc. 2023 Aug 4;25(3):118-125. doi: 10.1016/j.ccrj.2023.06.001. Erratum in: Crit Care Resusc. 2024 Feb 01;26(1):60. doi: 10.1016/j.ccrj.2024.01.003. PMID: 37876374; PMCID: PMC10581278.