Jump to content
MediMike

Hello ECMO...

Recommended Posts

Morning all-

So I've somewhat recently transitioned from academics to the private world, currently working in a quasi-tertiary care center (CTS/NSG/Trauma/Nephro) which is starting some talk about ramping up to an ECMO program.  Primarily VV to start with a transition to VA down the road.  I'm a little hesitant, not quite sure we'll achieve the numbers necessary to remain competent but I'm not the one calling the shots.

To any of you that DO manage circuits on a regular basis, any prep advice? I'm heading down to FL for a Mayo course in December, picking up the red book...Is the blue book helpful? My team are the only ones in house at night so we'll be troubleshooting the circuit as well as the nurses/RTs so want to make sure I have the best resources, the red book sounds like it covers all the physiology, indications etc., wasn't sure if it would cover the nuts and bolts of actually running the dang thing.

Thanks for any info!

Share this post


Link to post
Share on other sites

Interested to see the answers. While I don’t practice in an ICU anymore, I don’t think that ECMO is becoming more prevalent. Heck, they are starting it in the field in Europe. Don’t think it’ll be long before it could be a rural EM skill before transferring to a tertiary center

Share this post


Link to post
Share on other sites

Hello,

currently working at large tertiary care center in CTS. Read any and all material you can get your hands on. If you have any understanding or exposure to CPB, no significant difference. I personally used red book and asked questions to perfusionists.  I don’t know about your state legislation, but where I am, circuit has to be run by cardiac perfusionist currently. Looking to expand that to RT but I don’t believe it is passed law yet; certainly not in practice at my healthcare facility. 

 

Hope that helps. 

My best,

 

Dangle 

Share this post


Link to post
Share on other sites
12 hours ago, LT_Oneal_PAC said:

Interested to see the answers. While I don’t practice in an ICU anymore, I don’t think that ECMO is becoming more prevalent. Heck, they are starting it in the field in Europe. Don’t think it’ll be long before it could be a rural EM skill before transferring to a tertiary center

FYI, they just did the first field ECMO cannulation in North America earlier this month in Albuquerque; I've got a couple of buddies in EMS leadership down there and they have a very progressive system from the sounds of things.

https://www.abqjournal.com/1375453/unm-debuts-new-response-to-cardiac-arrest.html

  • Like 1

Share this post


Link to post
Share on other sites
44 minutes ago, medic25 said:

FYI, they just did the first field ECMO cannulation in North America earlier this month in Albuquerque; I've got a couple of buddies in EMS leadership down there and they have a very progressive system from the sounds of things.

https://www.abqjournal.com/1375453/unm-debuts-new-response-to-cardiac-arrest.html

Behind a paywall............

Share this post


Link to post
Share on other sites

The article:

Copyright © 2019 Albuquerque Journal

Doctors at the University of New Mexico Hospital have debuted a new technology, the first of its kind in North America, that they expect to dramatically expand the number of cardiac arrest cases that paramedics and other emergency staff can effectively treat.

Last week, doctors from UNM Hospital, alongside Albuquerque Ambulance Service and Albuquerque Fire Rescue hooked a patient up to an extracorporeal membrane oxygenation system, a rare life-support system that simulates the effect of a heart and a pair of lungs to keep cardiac arrest patients alive, in the field.

ADVERTISEMENTSKIP

 
 
 
00:0000:14
 
2_th.jpg?mode=crop&width=630&height=355&fit=bounds&crop=630:355,smart
 

Darren Braude, professor of emergency medicine with UNM Hospital, said during a news conference Monday that it was the first time a patient had received the treatment outside of a hospital on this side of the Atlantic Ocean, the product of a collaborative effort to make the technology more portable.

While the first patient ultimately died from the cardiac arrest over the weekend, UNM doctors said they were optimistic that the machine would increase the percentage of patients who survive cardiac arrest in Albuquerque by allowing patients who can’t be transported to the hospital in time to receive the same care as those who are.

“We’re trying to get to some of the outlying communities that are a little bit further away,” said Todd Dettmer, a critical care physician at UNM Hospital.

Cardiac arrest, which occurs when the heart suddenly stops beating and cannot pump blood to the brain, lungs and other organs, is a leading cause of death in the United States. Jon Marinaro, chief of critical care at UNM Hospital, said around 30% of people who experience cardiac arrest while outside a hospital survive nationwide, though that number drops rapidly if a patient hasn’t been revived after 20 minutes. He said just 1% of patients who haven’t been revived after 20 minutes survive with their full brain function intact.

Marinaro said extracorporeal membrane oxygenation (ECMO) systems can keep patients alive by removing blood from the right chamber of the heart, pressurizing and oxygenating the blood, and returning it to the patient, simulating the effect of a heart while the heart is stopped.

“This is an advanced procedure that is only available in a few hospitals,” Braude added.

However, Marinaro said patients must be hooked up to an ECMO system within an hour after collapsing. This means that there are areas of metro Albuquerque that are too far from the hospital for patients to be transported in time. Borrowing from a program used in Paris, the three agencies worked to mobilize the ECMO machines and bring them to patients outside that radius.

Chris Ortiz, EMS chief for Albuquerque Fire Rescue, said an AFR vehicle was outfitted with an ECMO system. In the event of a cardiac arrest emergency outside that radius, Ortiz said the truck carrying the ECMO system will meet other first responders onsite. The patient would then be hooked up to the ECMO system and transported to the hospital.

Ortiz added that patients must be between the ages of 18 and 75, and the cardiac arrest must be witnessed by family members or other bystanders.

While Marinaro said the program couldn’t save everyone who experiences cardiac arrest, he said it stands to make modern care available to many more Albuquerque residents. Going forward, the hospital is working to make the program more straightforward and cost-effective, allowing smaller, rural hospitals to implement it as well.

“One of my hopes is … to make it so simple that small places can offer this as well as large places,” Marinaro said.

Share this post


Link to post
Share on other sites

Elmo.jpg.8441be1dc7e1c8e06e54e8403ed6d73d.jpg 

My experience with ECMO.  Oh, it isn't the same thing?  Funnies aside, I find it interesting, in addition to the hypothermia argument.  Seems that ABQ would require onsite CPR as part of their criteria as well.

Edited by GetMeOuttaThisMess
  • Like 1

Share this post


Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.


×
×
  • Create New...

Important Information

Welcome to the Physician Assistant Forum! This website uses cookies to ensure you get the best experience on our website. Learn More