Curious to hear how you simulated the cannulation and were able to allow for blood to flow through the circuit. Any publications that exist to help start-up ECMO programs to incorporate simulation into training?
Wouldnt it make more sense to treat the coronary lesion first and then proceed to ecmo implantation under flouroscopy in the cath lab if the patient doesnt recover after reperfusion?
Good Question! No evidence to guide us here. Logistically it is much easier to cath a patient on ECMO rather than LUCAS. Also the ECMO first strategy prioritizes time to brain perfusion over time to coronary reperfusion.
Thanks for your reply! At my institution we argue a lot about that question... Personally, I think if the patient is in VF or ST elevation was documented pre arrest, its worthwile to do the cath first (because its likely to be very straighforward) and put the ecmo in later if its still necessary. If a coronary problem is not that likely, probably its better to implant the ecmo first. What do you do in pulmonary embolisms? We recently decided to implant the ecmo during cpr and then performed thrombolysis when ecmo circulation was established - patient went on to full recovery. You have any experiences in situations like these?
@@paclitaxel How would you cath someone who needed continous chest compressions? That's the whole point of ECPR as soon as possible isn't? To provide the brain with oxygenated blood with the hopes of preventing an anoxic brain injury and brain death. If the ECPR was delayed by proceeding to the cath lab first, then the chance of a significant anoxic brain injury and brain death would be greatly increased.
@@gskessingerable Hi Gary, in my experience, skilled interventional cardiologists are well capable of cathing someone with ongoing chest compressions, in particular when done by a device like LUCAS etc. It's been done like that for years before ECMO or eCPR very widely available in cath labs. Usually it's not a highly complicated thing to do, given that usually the lesions that need to be adressed under such circumstances are proximal fresh plaque ruptures with soft thrombi that can be passed quite easily. Mind you, that good quality CPR for these few minutes will likely provide sufficient cerebral oxygenation while salvaging myocardium by fast revascularization. But in the end, "(more) studies are needed".
@@robertkellis6033 Good quality CPR doesn't provide adequate cerebral oxygenation. CPR can only provide, at optimum performance, 20% of a person's oxygen. CPR cannot be relied upon to keep a person alive, or to prevent brain death. That's why getting ROSC is so vital.The longer CPR lasts without ROSC the chances of an anoxic brain injury increase dramatically. Delaying ECPR to take a cardiac arrest victim to the cath lab would do nothing but guarantee an anoxic brain injury and death. Lastly, CPR with frequent interuptions in chest compressions is virtually worthless. That's precisely what would occur in attempting to cath cardiac arrest victims with ongoing CPR.
great vedio we use ecmo in our cath lab.. 5 yrs now. great simulation
Curious to hear how you simulated the cannulation and were able to allow for blood to flow through the circuit. Any publications that exist to help start-up ECMO programs to incorporate simulation into training?
Conrad Hawkins? is that you on the background?
Wouldnt it make more sense to treat the coronary lesion first and then proceed to ecmo implantation under flouroscopy in the cath lab if the patient doesnt recover after reperfusion?
Good Question! No evidence to guide us here. Logistically it is much easier to cath a patient on ECMO rather than LUCAS. Also the ECMO first strategy prioritizes time to brain perfusion over time to coronary reperfusion.
Thanks for your reply! At my institution we argue a lot about that question... Personally, I think if the patient is in VF or ST elevation was documented pre arrest, its worthwile to do the cath first (because its likely to be very straighforward) and put the ecmo in later if its still necessary. If a coronary problem is not that likely, probably its better to implant the ecmo first. What do you do in pulmonary embolisms? We recently decided to implant the ecmo during cpr and then performed thrombolysis when ecmo circulation was established - patient went on to full recovery. You have any experiences in situations like these?
@@paclitaxel
How would you cath someone who needed continous chest compressions? That's the whole point of ECPR as soon as possible isn't? To provide the brain with oxygenated blood with the hopes of preventing an anoxic brain injury and brain death. If the ECPR was delayed by proceeding to the cath lab first, then the chance of a significant anoxic brain injury and brain death would be greatly increased.
@@gskessingerable Hi Gary, in my experience, skilled interventional cardiologists are well capable of cathing someone with ongoing chest compressions, in particular when done by a device like LUCAS etc. It's been done like that for years before ECMO or eCPR very widely available in cath labs. Usually it's not a highly complicated thing to do, given that usually the lesions that need to be adressed under such circumstances are proximal fresh plaque ruptures with soft thrombi that can be passed quite easily. Mind you, that good quality CPR for these few minutes will likely provide sufficient cerebral oxygenation while salvaging myocardium by fast revascularization. But in the end, "(more) studies are needed".
@@robertkellis6033
Good quality CPR doesn't provide adequate cerebral oxygenation. CPR can only provide, at optimum performance, 20% of a person's oxygen. CPR cannot be relied upon to keep a person alive, or to prevent brain death. That's why getting ROSC is so vital.The longer CPR lasts without ROSC the chances of an anoxic brain injury increase dramatically. Delaying ECPR to take a cardiac arrest victim to the cath lab would do nothing but guarantee an anoxic brain injury and death. Lastly, CPR with frequent interuptions in chest compressions is virtually worthless. That's precisely what would occur in attempting to cath cardiac arrest victims with ongoing CPR.
Size 6 tube....hmmm