ED ECMO
92 episodes - English - Latest episode: over 2 years ago - ★★★★★ - 82 ratingsResuscitationist-Initiated Extracorporeal Life Support
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Episodes
75: Pulmonary Embolism and ECPR
December 03, 2021 09:24 - 8 minutes - 8.25 MBIn this short episode, Zack makes two points. One, it was tough to get to where we are with ECMO acceptance. Two, cardiac arrest patients in PEA should be considered for ECPR. Below is the full editorial Zack and Alice did recently in the Journal of Resuscitation on the topic. It was born out of a fantastic German article centered looking at registry outcomes for PE and ECMO. Full Free Link to Editorial (until January 2022) - https://authors.elsevier.com/a/1eAXK_6ryqqpRd Article link - ...
74: Do 70 year old’s deserve ECPR? A Deep Dive into the Economics of ECPR
October 14, 2021 06:31 - 28 minutes - 25.8 MBHave you ever pondered whether all the work over ECPR was worth it? Even if you did save a few patients, does this really make sense from a societal standpoint? Am I giving up my life on a project where my efforts could be better elsewhere? Then this episode is for you (and me). This month I talk with Melissa Barnes and Ryan Coute about the economics of cardiac arrest and specifically ECPR. Ryan has just published a great paper in Resuscitation on the costs on OHCA. We will talk with Ry...
73b: Conclusions for Hyperinvasive Trial with Jan Belohlavek
May 24, 2021 04:36 - 5 minutes - 4.13 MBHere is the conclusion for the interview of Jan Belohlavek and his Hyperinvasive Trial
73:The Hyperinvasive Trial with Jan Belohlavek
May 24, 2021 04:34 - 53 minutes - 47.6 MBWait...ECPR works? To the believers, this has been a foregone conclusion. To the rest of the world, the question of whether ECPR improves cardiac arrest survivorship has been in question. Jan Belohlavek and his Prague colleagues just presented their 8 year data showing better outcomes in cardiac arrest patients that got a grouped therapy of early transport, prehospital hypothermia, mechanical chest compressions, and ECMO over those who got a traditional resuscitation. This study is key and...
72: Should We All Switch To Bivalirudin?
March 25, 2021 00:37 - 29 minutes - 24.3 MBHeparin has been the mainstay of anticoagulation for ECMO patients for years. In recent years, this has been challenged. Bivalirudin has b ecome a potential better anticoagulant. Troy Seelhammer in EDECMO episode 55 gave us some insight into this. This month Ryan Rivosecchi and his crew at UPitt have released their findings in Critical Care Medicine. This retrospective study suggests great improvement in major bleeding in patients who received Bivalirudin compare to Heparin (40.7% vs 11....
71: Should We Prioritize VV-ECMO over ECPR?
February 24, 2021 06:31 - 37 minutes - 31.4 MBIn this episode, we dive into the abyss of resource allocation. Much of the world is saying that the limited number of ECMO circuits should be used for COVID induced lung injury. This means that ECPR initiatives have been shut down or severely limited. Is this the right thing to do? What does the data say? What strategy gives the most benefit to the most people? Zack invited Brian Grunau to discuss these topics as well as a recent ECPR paper out of Norway and study dealing with signs of...
70: REBOA REDUX – Management of Hemorrhagic Shock in Non-Trauma Patients – with Bellezzo & Zaf Qasim
January 02, 2021 06:26 - 53 minutes - 49.2 MBIn this episode Joe Bellezzo talks with Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) expert Zaf Qasim about NON-TRAUMA applications of aortic compression for control of non-compressible non-trauma torso hemorrhage.
69: 2020 Synopsis
December 18, 2020 18:03 - 11 minutes - 9.28 MB2020 was a crazy year. This month Zack goes through the biggest ECMO lessons learned in 2020. This is a short concise run through of ECPR, ECMO for COVID, Imaging, and Aortic Dissection. It's a reminder of how organization is so critical to the outcome of your ECMO program. He also reminds us how improvement in these systems of care can lead to survival rates even the believers in ECMO thought were unattainable.
68: ARREST – The First Randomized ECPR Trial Ever
November 22, 2020 18:30 - 47 minutes - 31.5 MBThe ARREST Trial is published! Demetris Yannopoulos, Jason Bartos and their army of rockstars have done it! This is the first randomized ECPR trial and it showed tremendous benefit of ECPR compared to traditional therapies. Zack explores this paper and their concurrent publication of process with Demetris. Their two Lancet papers are below https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32338-2/fulltext https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(2...
67: Da DO2: Fundamental ECMO Physiology with Sage Whitmore
October 14, 2020 07:36 - 33 minutes - 24.3 MBHave 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
66: Crash VV ECMO
September 07, 2020 12:50 - 36 minutes - 29.7 MBHave 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, whe...
65: ECPR Journal Club: Dual Sequential Defibrillation, CT after ECMO, and much, much more
May 23, 2020 08:43 - 33 minutes - 27.5 MBThis 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!
64: Contraindicated??? – Long Live the Aortic Dissection with Garrett Sterling
April 23, 2020 19:28 - 32 minutes - 26.5 MBIn 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?"
63: Covid and ECMO – Who do we cannulate? with Jenelle Badulak
March 22, 2020 05:31 - 23 minutes - 19.1 MB"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 B...
62: Jason Bartos Take 2: The Future of ECPR Now
February 18, 2020 14:12 - 27 minutes - 22 MBLast 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!
61: Jason Bartos – ECPR Redefined
January 30, 2020 14:18 - 36 minutes - 29.2 MBJason 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 ...
60: ECPR 2.0 with Scott Weingart
December 03, 2019 01:12 - 51 minutes - 41.2 MBToday's episode focuses on the differences between ECMO physiology in the patient in cardiogenic shock versus the one in cardiac arrest.
59: Partial REBOA and US PreHospital ECPR Revisited
November 04, 2019 19:18 - 35 minutes - 23 MBThis 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 gr...
58: First U.S. Pre-Hospital ECPR Program
September 30, 2019 19:56 - 30 minutes - 24.8 MBThe 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.
57: The New REBOA catheter – Perfecting the Partial Occlusion
September 07, 2019 19:13 - 34 minutes - 28.5 MBOver 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 pub...
56: Pressors, Fluid, or Flow – Optimizing ECMO Physiology
July 08, 2019 06:05 - 36 minutes - 29.7 MBA 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.
55 – Anticoagulation of the ECMO Patient with Troy Seelhammer
June 04, 2019 17:34 - 31 minutes - 25.2 MBDo 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 an...
54: Confirmation of Wire Placement with Sacha Richardson
May 08, 2019 16:07 - 23 minutes - 19.6 MBIn 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.
53b: Resuscitationist Inserted Distal Perfusion Catheter with Chris Couch
April 04, 2019 16:31 - 29 minutes - 24.1 MBIn 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,...
53: Distal Perfusion Catheter with Joe Dubose
April 01, 2019 17:40 - 27 minutes - 22.2 MBEpisode 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.
52: Brain Freeze- Selective Retrograde Cerebral Perfusion for Intra-Arrest Neuroprotection
March 05, 2019 18:56 - 23 minutes - 19 MBWe'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!
51 – Proximal Balloon Occlusion for Cardiac Arrest
February 12, 2019 18:34 - 27 minutes - 22.5 MBYou'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 w...
50b Inter-Facility Transport of ECMO patients Part 2 of 2
December 05, 2018 22:20 - 48 minutes - 44 MBThis 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!
50a Inter-facility Transport of ECMO patients Part 1 of 2
December 05, 2018 20:29 - 22 minutes - 23.5 MBThis 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 s...
49 – You Can’t Spell REBOA without the ER – Endovascular Resuscitation of the Trauma Patient – Zaf Qasim
October 12, 2018 14:27 - 27 minutes - 30.1 MBn 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 resuscit...
EDECMO 48: When Should I Transport a Cardiac Arrest?
August 10, 2018 12:14 - 35 minutes - 28.3 MBThis 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.
EDECMO 47: ECMO Donazione: Organ Transplantation with Velia Antonini
August 04, 2018 20:04 - 15 minutes - 11.8 MBOver 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.
EDECMO 46: Wire Assistant
July 06, 2018 02:21 - 25 minutes - 20.5 MBWell, 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 sh...
EDECMO 45: ECMO in Sepsis
May 10, 2018 23:12 - 31 minutes - 25.1 MBIn 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...
EDECMO Crash Episode – Demetris Yannopoulos on ECPR-the Minneapolis Way
April 08, 2018 18:49 - 1 hour - 445 MB VideoYanno on ECPR
EDECMO 44: Bob Bartlett: Peristaltic Pumps, Hollow Fibers, and the History of ECMO
March 22, 2018 00:12 - 36 minutes - 29.8 MBIn 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 ho...
EDECMO 43: The Cutdown
February 20, 2018 17:06 - 29 minutes - 24 MBIn 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 visua...
EDECMO 42: Organ Transplantation On ECMO
January 16, 2018 16:19 - 32 minutes - 26.2 MBIn 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 Paris, and Cyrus Olsen, ethicist from the University of Scranton, to dive into some of the deeper questions including...
EDECMO 41 – The 3 Stages of ECPR – Diane’s Story
December 30, 2017 02:04 - 30 minutes - 42.2 MBIn 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.
EDECMO 40: EROCA – The trial that asks “Should ER Docs Initiate ECPR?”
November 02, 2017 20:00 - 28 minutes - 23 MBEROCA - 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 to fund an out of hospital cardiac arrest protocol for emergency physician initiated ECPR. In this episode, Zack asks Kyle how this trial is being undertaken wi...
EDECMO 39: Who Do We Put On ECMO? – New Data on Prognostics
October 06, 2017 04:43 - 36 minutes - 31 MBIn 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 ...
Crash Episode: Iowa OHCA ECMO Save – with Andrew Karl Terry
September 07, 2017 05:20 - 11 minutes - 8.98 MBMini 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!
EDECMO 38 – ECMO and Trauma – with Pal Ager-Wick and Magnus Larsson
August 28, 2017 00:13 - 31 minutes - 43.5 MBThis 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.
EDECMO 37 – Nate’s Story
July 21, 2017 18:20 - 32 minutes - 44.9 MBJake 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.
Crash Episode – MicroDissection of Yannopoulos’ ECMO Method
July 15, 2017 20:50 - 35 minutes - 32.8 MBThe University of Minnesota Cath Lab Cannulation Method
EDECMO 36 – Crushing the Nihilism of Cardiac Arrest – with Demetris Yannopoulos
June 09, 2017 22:40 - 29 minutes - 40 MBIn 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...
EDECMO 35 – REBOA REVISITED!
April 07, 2017 19:29 - 34 minutes - 47.8 MBREBOA (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:
EDECMO 34 – The Day After REANIMATE – with Dr. Sean Deitch
March 15, 2017 20:07 - 16 minutes - 14.8 MBIn 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 R...
EDECMO 33a – “Bringing Down the House” by Zack Shinar (from RESUSfest 2016)
January 26, 2017 07:49 - 19 minutes - 26.4 MBIn 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.
EDECMO 32 – Archimedes Screw: Is Impella the Future of Mechanical Circulatory Support?
December 07, 2016 00:34 - 37 minutes - 30.2 MBIn 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.