ECMO for cardiac arrest patients: Update 2017

Size: px
Start display at page:

Download "ECMO for cardiac arrest patients: Update 2017"

Transcription

1 ECMO for cardiac arrest patients: Update 2017 Lim Swee Han MBBS (NUS), FRCS Ed (A&E), FRCP (Edin), FAMS Senior Consultant, Department of Emergency Medicine, Singapore General Hospital Adjunct Associate Professor, Yong Loo Lin School of Medicine and Duke-NUS Graduate Medical School of National University of Singapore Treasurer and Member BLS Taskforce, ILCOR Chairman, Resusciation Council of Asia Secretary, Asian Society for Emergency Medicine President, Society of Emergency Medicine in Singapore

2 Acknowledgements Dr Lim Jia Hao Consultant Department of Emergency Medicine Singapore General Hospital Dr Tan Boon Kiat Kenneth Consultant Department of Emergency Medicine Singapore General Hospital

3 What is ECMO? The use of extracorporeal circulation and gas exchange to provide TEMPORARY life support in patients with REVERSIBLE pulmonary and/or cardiac failure.

4 History of ECMO Dimethylpolysiloxane (DMPS, silicone), was discovered in 1957, and by 1963, used in the construction of oxygenators It will pave the way for extracorporeal life support systems

5 First Successful ECLS Patient, 1971

6 First Cardiac ECMO Survivor, 1972 First Neonatal ECMO Survivor, 1975

7 ELSO Extracorporeal Life Support Organization Established 1989 Outgrowth of a study group contributing to a registry of cases starting in 1984 Surgeons, neonatologists, nurses, perfusionists, RTs, biomedical engineers Develops ECLS guidelines, textbooks, and maintains a registry

8 Types of ECMO Veno-arterial ECMO Used for refractory cardiogenic shock and for E CPR Veno-venous ECMO Usually used for respiratory failure refractory to other conventional treatments. Conditions like severe pneumonia, Pneumonitis

9 V-V ECMO Indications Adult Respiratory Distress Syndrome (ARDS) Pneumonia Trauma Graft failure following lung transplantation Paediatric and neonatal respiratory support E.g., HMD, MAS, PPHN, CDH etc Extensive research done in this patient population

10 V-A ECMO Severe cardiac failure Decompensated cardiomyopathies Myocarditis Acute coronary syndromes with cardiogenic shock Profound cardiac depression due to drug overdose or sepsis Post-cardiotomy or post-heart transplant Cardiac arrest (<15 min, with excellent CPR)

11 Increased Survival Adult ARDS survival up to 70% Paeds ARDS survival up to 75% For cardiogenic shock: Myocarditis 70% Decompensated CMP 50% Cardiogenic shock with ACS 40% In-hospital cardiac arrest 34% Out-of-hospital cardiac arrest 13%

12 ECLS vs CPB Feature CPB ECMO Duration Hours Days to Months Configuration VA bypass VA or VV Membrane Microporous Nanoporous Blood pump Roller Centrifugal Circuit volume Large Small Anticoagulation High Low Reservoir Large Small or absent Cannulation Central (RA to aorta) Peripheral Patient Anaesthetized, paralysed Awake, or sedated Management Perfusionist Nurse, Perfusionist, RT

13 ECMO Circuit About min to prime a full circuit Lasts about 30 days

14 Components of Circuit (I) Access Cannula: Distal tip has multiple holes and a main central lumen; drains deoxygenated blood from venous system Return Cannula Single end lumen; returns oxygenated blood back to patient

15 Components of Circuit Centrifugal Pump Head Artificial heart that pushes the deoxygenatd blood into the oxygenator Pressure differential at inlet and outlet results in flow Oxygenator with integrated heat exhanger Artificial lung where gas exchange takes place Temperature regulation

16 Components of Circuit (II) Monitor displaying venous O2 saturation and HCT Pump console and drive motor to adjust flow Flow probes and flow sensors Circuit pressure monitors (pre-pump, post-pump) Heater/cooler unit with temperature display Frequent inspections for clots in circuit Watch for circuit chatter Minimize excessive connections e.g., stopcocks, tube connectors etc Minimize length CLAMPS and TORCHLIGHT readily available

17 ECMO Complications (I) Haemorrhage Embolism Leg ischaemia Infection Anticoagulation and resultant bleeding Balancing act between sufficient anticoagulation, and thrombosis Cerebrovascular infarct / bleed Pulmonary oedema Sepsis Increase in LV afterload

18 ECMO Complications (II) Non-pulsatile (if high flow VA ECMO) Altered physiology Harlequin syndrome flow competition in the aorta (native cardiac output, vs retrograde aortic perfusion from arterial cannula), if pulmonary function impaired, then: Blue head Red legs Always measure SpO2 and blood gases on R side

19

20 Extracorporeal membrane oxygenation support

21 In-hospital cardiac arrest Aged who underwent CPR >10min Cardiac origin raised cardiac enzymes before CPR, sudden collapse without obvious causes, or with pre-existing cardiovascular disease Exclusion Criteria: Severe irreversible brain damage Terminal malignancy Traumatic origin with uncontrolled bleeding Non-cardiac arrest Previously signed Do not attempt resuscitation Chen, Lancet 2008,

22 In-hospital cardiac arrest Chen, Lancet 2008,

23 In-hospital cardiac arrest Chen, Lancet 2008,

24 ECRP vs CCPR in adults OHCA: A prospective observational study Inclusion criteria: 1. VF/VT initial ECG 2. Cardiac arrest on hospital arrival with or without pre-hospital ROSC 3. Within 45min from reception of the emergency call or onset of cardiac arrest to the hospital arrival 4. No ROSC at least during the 15min after hospital arrival (ROSC defined as at least 1min of continuing confirmation of pulsation) Exclusion criteria: 1. Under 20 years old, or 75 years and older 2. Poor level of activities of daily livings before onset of cardiac arrest 3. Non-cardiac origin (eg external factors such as trauma and drug intoxication, primary cerebral disorders, acute aortic dissection diagnosed prior to the introduction of PCPS, and terminal phase of cancer) 4. Core body temperature less than 30 C Sakamoto T Resuscitation 2014

25 Sakamoto T Resuscitation 2014

26

27 Patients with refractory OHCA were eligible for the study if aged years cardiac arrest due to suspected cardiac aetiology chest compressions commenced within 10 mins by bystanders or EMS initial cardiac arrest rhythm of ventricular fibrillation (VF) mechanical CPR machine (Autopulse) available Patients with IHCA were eligible at the discretion of the attending critical care physician when it was considered likely that the cardiac arrest would be reversible if venoarterial ECMO and definitive treatment could be provided immediately. Patients with IHCA were excluded if they were known to have significant pre-existing neurological disability Non-cardiac co-morbidities that cause limitations in activities of daily living such as severe chronic airways disease, cirrhosis of the liver, renal failure on dialysis and terminal malignancy Patients with cardiac arrest and ROSC followed by cardiogenic shock who were later treated with veno-arterial ECMO are not included in this report Dion et al. Resuscitation 2015

28 Dion et al. Resuscitation 2015

29

30 A Bunch of Caveats: Patient selection is crucial Centers with high volume of ECMO patients demonstrate the best outcomes Scrutinize the evidence observational studies++, small numbers No randomized study data available for ECMO/ECLS use in cardiogenic shock

31 A Dash of Cold Water ECMO resuscitates the moribund it cannot reanimate the dead. It remains a non-durable technology ECLS itself is a relatively simple procedure, however, the management paradigms are complex ECLS accomplishes nothing (non-therapeutic), but facilitates EVERYTHING It can support patients awaiting good clinical decision making it is ineffective in supporting bad clinical decisions It truly is a bridge

32 End

To ECMO Or Not To ECMO Challenges of venous arterial ECMO. Dr Emily Granger St Vincent s Hospital Darlinghurst NSW

To ECMO Or Not To ECMO Challenges of venous arterial ECMO. Dr Emily Granger St Vincent s Hospital Darlinghurst NSW To ECMO Or Not To ECMO Challenges of venous arterial ECMO Dr Emily Granger St Vincent s Hospital Darlinghurst NSW The Start: 1972 St Vincent s Hospital The Turning Point ECMO program restarted in 2004

More information

Guideline of Singapore CPR

Guideline of Singapore CPR KACPR Symposium Guideline of Singapore CPR Lim Swee Han MBBS (NUS), FRCS Ed (A&E), FRCP (Edin), FAMS Senior Consultant, Department of Emergency Medicine, Singapore General Hospital Adjunct Associate Professor,

More information

ECMO BASICS CHLOE STEINSHOUER, MD PULMONARY AND SLEEP CONSULTANTS OF KANSAS

ECMO BASICS CHLOE STEINSHOUER, MD PULMONARY AND SLEEP CONSULTANTS OF KANSAS ECMO BASICS CHLOE STEINSHOUER, MD PULMONARY AND SLEEP CONSULTANTS OF KANSAS DISCLOSURES No financial disclosures or conflicts of interest OBJECTIVES Define ECMO/ECLS and be able to identify the main types

More information

E-CPR National Trends & Local Plans

E-CPR National Trends & Local Plans E-CPR National Trends & Local Plans Objectives What is E-CPR? Jon Marinaro MD FCCM Chief, Surgical Critical Care UNM Associate Director UNM Adult ECMO Program Why would one do it? Evidence behind E-CPR?

More information

E-CPR National Trends & Local Plans

E-CPR National Trends & Local Plans E-CPR National Trends & Local Plans Jon Marinaro MD FCCM Chief, Surgical Critical Care UNM Associate Director UNM Adult ECMO Program Objectives What is E-CPR? Why would one do it? Evidence behind E-CPR?

More information

EXTRA CORPOREAL MEMBRANE OXYGENATION

EXTRA CORPOREAL MEMBRANE OXYGENATION EXTRA CORPOREAL MEMBRANE OXYGENATION Basic Overview and Case Study Bob Hayes, Chief Perfusionist Enloe Medical Center Jenny Humphries, RN, BSN, MBA, CFRN Chief Flight Nurse, Enloe FlightCare Normal Cardiopulmonary

More information

ECMO Primer A View to the Future

ECMO Primer A View to the Future ECMO Primer A View to the Future Todd J. Kilbaugh Assistant Professor of Anesthesiology, Critical Care Medicine, and Pediatrics Director of The ECMO Center at the Children s Hospital of Philadelphia Disclosures

More information

ECMO as a bridge to durable LVAD therapy. Jonathan Haft, MD Department of Cardiac Surgery University of Michigan

ECMO as a bridge to durable LVAD therapy. Jonathan Haft, MD Department of Cardiac Surgery University of Michigan ECMO as a bridge to durable LVAD therapy Jonathan Haft, MD Department of Cardiac Surgery University of Michigan Systolic Heart Failure Prevalence 4.8 million U.S. 287,000 deaths per year $39 billion spent

More information

Adult Extracorporeal Life Support (ECLS)

Adult Extracorporeal Life Support (ECLS) Adult Extracorporeal Life Support (ECLS) Steven Scott, M.D., F.A.C.S. Piedmont Heart Institute Cardiothoracic Surgery Disclosures None ECMO = ECLS A technique of life support that involves a continuous

More information

Extra Corporeal Life Support for Acute Heart failure

Extra Corporeal Life Support for Acute Heart failure Extra Corporeal Life Support for Acute Heart failure Benjamin Medalion, MD Director Heart and Lung Transplantation Department of Cardiothoracic Surgery Rabin Medical Center, Beilinson Campus, Israel Mechanical

More information

CPR What Works, What Doesn t

CPR What Works, What Doesn t Resuscitation 2017 ECMO and ECLS April 1, 2017 Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville, TN Circulation 2013;128:417-35

More information

AllinaHealthSystem 1

AllinaHealthSystem 1 : Definition End-organ hypoperfusion secondary to cardiac failure Venoarterial ECMO: Patient Selection Michael A. Samara, MD FACC Advanced Heart Failure, Cardiac Transplant & Mechanical Circulatory Support

More information

FOCUS CONFERENCE 2018

FOCUS CONFERENCE 2018 FOCUS CONFERENCE 2018 Current Practice in Pediatric and Neonatal Extracorporeal Life Support Daniel W. Chipman, RRT Assistant Director of Respiratory Care Massachusetts General Hospital Boston, Massachusetts

More information

Extracorporeal Life Support (ECLS)

Extracorporeal Life Support (ECLS) Extracorporeal Life Support (ECLS) Moderatore: A. Spagna Discussant M. Rugna, A. Peris, G. Gerosa, M. Raimondi, P. Rosi ADRIANO PERIS- CURE INTENSIVE DEL TRAUMA E SUPPORTI EXTRACORPOREI AOUC- FIRENZE PLANNING

More information

Lesta Whalen, MD Medical Director, Sanford ECMO Pediatric Critical Care

Lesta Whalen, MD Medical Director, Sanford ECMO Pediatric Critical Care Lesta Whalen, MD Medical Director, Sanford ECMO Pediatric Critical Care Disclosures I have no financial disclosures. The use of certain devises for providing long-term cardiopulmonary support is investigational.

More information

Case scenario V AV ECMO. Dr Pranay Oza

Case scenario V AV ECMO. Dr Pranay Oza Case scenario V AV ECMO Dr Pranay Oza Case Summary 53 y/m, k/c/o MVP with myxomatous mitral valve with severe Mitral regurgitation underwent Mitral valve replacement with mini thoracotomy Pump time nearly

More information

Disclosures. Extra-Corporeal Membrane Oxygenation During Cardio- Pulmonary Resuscitation ECPR April 22, 2016 ECG. Case. Case. Case Summary 4/22/2016

Disclosures. Extra-Corporeal Membrane Oxygenation During Cardio- Pulmonary Resuscitation ECPR April 22, 2016 ECG. Case. Case. Case Summary 4/22/2016 Extra-Corporeal Membrane Oxygenation During Cardio- Pulmonary Resuscitation ECPR April 22, 2016 Nothing to disclose. Disclosures Ivan J Chavez MD Case ECG History 60 y/o male No prior history of CAD In

More information

Resuscitation Science : Advancing Care for the Sickest Patients

Resuscitation Science : Advancing Care for the Sickest Patients Resuscitation Science : Advancing Care for the Sickest Patients William Hallinan University of Rochester What is resuscitation science? Simply the science of resuscitation : Pre arrest Arrest care Medical

More information

Extracorporeal Membrane Oxygenation (ECMO)

Extracorporeal Membrane Oxygenation (ECMO) Extracorporeal Membrane Oxygenation (ECMO) Policy Number: Original Effective Date: MM.12.006 05/16/2006 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 01/01/2017 Section: Other/Miscellaneous

More information

Echo assessment of patients with an ECMO device

Echo assessment of patients with an ECMO device Echo assessment of patients with an ECMO device Evangelos Leontiadis Cardiologist 1st Cardiology Dept. Onassis Cardiac Surgery Center Athens, Greece Gibbon HLM 1953 Goldstein DJ et al, NEJM 1998; 339:1522

More information

Extracorporeal Life Support Organization (ELSO) Guidelines for Pediatric Respiratory Failure

Extracorporeal Life Support Organization (ELSO) Guidelines for Pediatric Respiratory Failure Extracorporeal Life Support Organization (ELSO) Guidelines for Pediatric Respiratory Failure Introduction This pediatric respiratory failure guideline is a supplement to ELSO s General Guidelines for all

More information

Out-of-hospital Cardiac Arrest. Franz R. Eberli MD, FESC, FAHA Cardiology Triemli Hospital Zurich, Switzerland

Out-of-hospital Cardiac Arrest. Franz R. Eberli MD, FESC, FAHA Cardiology Triemli Hospital Zurich, Switzerland Out-of-hospital Cardiac Arrest Franz R. Eberli MD, FESC, FAHA Cardiology Triemli Hospital Zurich, Switzerland Conflict of Interest I have no conflict of interest to disclose regarding this presentation.

More information

Acute heart failure: ECMO Cardiology & Vascular Medicine 2012

Acute heart failure: ECMO Cardiology & Vascular Medicine 2012 Acute heart failure: ECMO Cardiology & Vascular Medicine 2012 Lucia Jewbali cardiologist-intensivist 14 beds/8 ICU beds Acute coronary syndromes Heart failure/ Cardiogenic shock Post cardiotomy Heart

More information

Veno-Venous ECMO Support. Chris Cropsey, MD Sept. 21, 2015

Veno-Venous ECMO Support. Chris Cropsey, MD Sept. 21, 2015 Veno-Venous ECMO Support Chris Cropsey, MD Sept. 21, 2015 Objectives List indications and contraindications for ECMO Describe hemodynamics and oxygenation on ECMO Discuss evidence for ECMO outcomes Identify

More information

Extracorporeal Membrane Oxygenation (ECMO)

Extracorporeal Membrane Oxygenation (ECMO) Extracorporeal Membrane Oxygenation (ECMO) Policy Number: Original Effective Date: MM.12.006 05/16/2006 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 11/01/2014 Section: Other/Miscellaneous

More information

Extracorporeal membrane oxygenators (ECMO) provide

Extracorporeal membrane oxygenators (ECMO) provide Case Report Interhospital Transport of the ECMO Patients in Bangkok Hospital Abstract An extracorporeal membrane oxygenator (ECMO) is used to support the heart and lungs in patients with severe cardiogenic

More information

Management of Cardiogenic Shock. Dr Stephen Pettit, Consultant Cardiologist

Management of Cardiogenic Shock. Dr Stephen Pettit, Consultant Cardiologist Dr Stephen Pettit, Consultant Cardiologist Cardiogenic shock Management of Cardiogenic Shock Outline Definition, INTERMACS classification Medical management of cardiogenic shock PA catheters and haemodynamic

More information

In the setting of liver failure & transplantation?

In the setting of liver failure & transplantation? ECMO: In the setting of liver failure & transplantation? Dr. Robert Loveridge MA LL.M MRCP FRCA FFICM Consultant in adult & liver intensive care medicine King s College Hospital NHS Foundation Trust What

More information

Cardiovascular Institute

Cardiovascular Institute Allegheny Health Network Cardiovascular Institute Extracorporeal Membrane Oxygenation (ECMO) Program Our patient survival rate is higher than the national average. ECMO experts. Multidisciplinary team.

More information

ECMO for Refractory Septic Shock Prof. Alain Combes

ECMO for Refractory Septic Shock Prof. Alain Combes ECMO for Refractory Septic Shock Prof. Alain Combes Service de Réanimation ican, Institute of Cardiometabolism and Nutrition Hôpital Pitié-Salpêtrière, AP-HP, Paris Université Pierre et Marie Curie, Paris

More information

ISPUB.COM. Concepts Of Neonatal ECMO. D Thakar, A Sinha, O Wenker HISTORY PATIENT SELECTION AND ECMO CRITERIA

ISPUB.COM. Concepts Of Neonatal ECMO. D Thakar, A Sinha, O Wenker HISTORY PATIENT SELECTION AND ECMO CRITERIA ISPUB.COM The Internet Journal of Emergency and Intensive Care Medicine Volume 5 Number 2 D Thakar, A Sinha, O Wenker Citation D Thakar, A Sinha, O Wenker.. The Internet Journal of Emergency and Intensive

More information

Extracorporeal Membrane Oxygenation (ECMO) Referrals

Extracorporeal Membrane Oxygenation (ECMO) Referrals Children s Acute Transport Service Clinical Guideline Extracorporeal Membrane Oxygenation (ECMO) Referrals Document Control Information Author ECMO/CATS Author Position Service Coordinator Document Owner

More information

Section 6 Intra Aortic Balloon Pump

Section 6 Intra Aortic Balloon Pump Section 6 Intra Aortic Balloon Pump The Intra Aortic Balloon Pump (IABP) The balloon is synthetic and is made for single use only. It is threaded into the aorta, usually via a femoral approach. The balloon

More information

Samphant Ponvilawan Bumrungrad International

Samphant Ponvilawan Bumrungrad International Samphant Ponvilawan Bumrungrad International Definitions Artificial circulation using VA ECMO as an alternative to ventilation and external cardiac massage Indications Out-of-Hospital Cardiac Arrest (OHCA)

More information

BASIC CRITICAL CARE OF THE PATIENT. Hannelisa Callisen PA C February 2017

BASIC CRITICAL CARE OF THE PATIENT. Hannelisa Callisen PA C February 2017 BASIC CRITICAL CARE OF THE PATIENT Hannelisa Callisen PA C February 2017 Disclosures Industry: None ECMO is off label Objectives ECMO initiation selection, cannulation Physiology : Review of DO2 on ECMO

More information

ECMO and refractory Hypoxemia

ECMO and refractory Hypoxemia ECMO and refractory Hypoxemia Dr. Vinay Dhingra MD FRCPC Clinical Associate Professor of Medicine Clinical Lead Critical Care BCPSQC Medical Director Quality VGH Disclosures ARDS Lancet 1967; 2:319-323

More information

10/16/2017. Review the indications for ECMO in patients with. Respiratory failure Cardiac failure Cardiorespiratory failure

10/16/2017. Review the indications for ECMO in patients with. Respiratory failure Cardiac failure Cardiorespiratory failure Review the indications for ECMO in patients with Respiratory failure Cardiac failure Cardiorespiratory failure 1 Extracorporeal membrane lung and/or cardiac support. A support therapy, in no way definitive.

More information

ECLS as Bridge to Transplant

ECLS as Bridge to Transplant ECLS as Bridge to Transplant Marcelo Cypel MD, MSc Assistant Professor of Surgery Division of Thoracic Surgery Toronto General Hospital University of Toronto Application of ECLS Bridge to lung recovery

More information

ECMO CPR. Ravi R. Thiagarajan MBBS, MPH. Cardiac Intensive Care Unit

ECMO CPR. Ravi R. Thiagarajan MBBS, MPH. Cardiac Intensive Care Unit ECMO CPR Ravi R. Thiagarajan MBBS, MPH Staff Intensivist Cardiac Intensive Care Unit Children s Hospital Boston PCICS 2008, Miami, FL No disclosures Disclosures Outline Outcomes for Pediatric in-hospital

More information

PRE-CONGRESS Thursday, 7 th May 2015

PRE-CONGRESS Thursday, 7 th May 2015 PRE-CONGRESS Thursday, 7 th May 2015 Lecture Theater A2 Helicopter Room a Room b Room c Room C4 Hangar 12 :00 13 :00 Congress Registration 13 :00 14 :45 Session A: Practical ECLS in 2015 aspects of ECLS

More information

CURRENT STATUS OF EXTRACORPOREAL LIFE SUPPORT FOR CARDIOPULMONARY FAILURE

CURRENT STATUS OF EXTRACORPOREAL LIFE SUPPORT FOR CARDIOPULMONARY FAILURE CURRENT STATUS OF EXTRACORPOREAL LIFE SUPPORT FOR CARDIOPULMONARY FAILURE Dr Susanna Price MBBS BSc MRCP EDICM PhD FFICM FESC Consultant Cardiologist & Intensivist Royal Brompton Hospital, London DECLARATION

More information

Epidemiology of Heart Failure in Adults

Epidemiology of Heart Failure in Adults Cardiac Critical Care : Focused on IABP & PCPS Epidemiology of Heart Failure in Adults Prevalence Incidence Mortality 2004 Hospital Cost 2007 2004 Age 20+ (New Cases) All Ages Discharges Age 35+ 2004 All

More information

Innovative ECMO Configurations in Adults

Innovative ECMO Configurations in Adults Innovative ECMO Configurations in Adults Practice at a Single Center with Platinum Level ELSO Award for Excellence in Life Support Monika Tukacs, BSN, RN, CCRN Columbia University Irving Medical Center,

More information

CCAS CPB Workshop Curriculum Outline Perfusion: What you might not know

CCAS CPB Workshop Curriculum Outline Perfusion: What you might not know CCAS CPB Workshop Curriculum Outline Perfusion: What you might not know Scott Lawson, CCP Carrie Striker, CCP Disclosure: Nothing to disclose Objectives: * Demonstrate how the cardiopulmonary bypass machine

More information

Which mechanical assistance for cardiogenic shock?

Which mechanical assistance for cardiogenic shock? Which mechanical assistance for cardiogenic shock? Alain Combes, MD, PhD, Hôpital Pitié-Salpêtrière, AP-HP Inserm UMRS 1166, ican, Institute of Cardiometabolism and Nutrition Pierre et Marie Curie Sorbonne

More information

ECLS Registry Form Extracorporeal Life Support Organization (ELSO)

ECLS Registry Form Extracorporeal Life Support Organization (ELSO) ECLS Registry Form Extracorporeal Life Support Organization (ELSO) Center ID: Center name: Run No (for this patient) Unique ID: Birth Date/Time Sex: (M, F) Race: (Asian, Black, Hispanic, White, Other)

More information

Mechanical Circulatory Support (MCS): What Every Pharmacist Needs to Know!

Mechanical Circulatory Support (MCS): What Every Pharmacist Needs to Know! Mechanical Circulatory Support (MCS): What Every Pharmacist Needs to Know! Matthew A. Wanat, PharmD, BCPS, BCCCP, FCCM Clinical Assistant Professor University of Houston College of Pharmacy Clinical Pharmacy

More information

Guideline compliance, utilization trends

Guideline compliance, utilization trends Guideline compliance, utilization trends and device selection Tilmann Schwab Cardiology / Intensive care Cardiac support IABP LVAD Transluminal l LVAD Cardiac support Emergency cardiac life support (ECLS)

More information

Maternal Collapse Guideline

Maternal Collapse Guideline Maternal Collapse Guideline Guideline Number: 664 Supersedes: Classification Clinical Version No: Date of EqIA: Approved by: Date Approved: Date made active: Review Date: 1 Obstetric Written Documentation

More information

Artificial Lung: A New Inspiration

Artificial Lung: A New Inspiration Artificial Lung: A New Inspiration Joseph B. Zwischenberger MD Johnston-Wright Professor and Chairman: Department of Surgery j.zwische@uky.edu The University of Kentucky Lexington, Kentucky Presenter Disclosure

More information

ECLS. The Basics. Jeannine Hermens Intensive Care Center UMC Utrecht

ECLS. The Basics. Jeannine Hermens Intensive Care Center UMC Utrecht ECLS The Basics Jeannine Hermens Intensive Care Center UMC Utrecht Conflict of interest None Terminology ECMO - ExtraCorporeal Membrane Oxygenation ECLS - ExtraCorporeal Life Support PLS - Veno-venous

More information

Outcomes with ECMO for In Hospital Cardiac Arrest

Outcomes with ECMO for In Hospital Cardiac Arrest Outcomes with ECMO for In Hospital Cardiac Arrest Subhasis Chatterjee, MD, FACS, FACC, FCCP. ECMO Program Director CHI Baylor St. Lukes Medical Center/ Texas Heart Institute Asst. Professor of Surgery,

More information

ECMO and VAD implantation

ECMO and VAD implantation 1 Udine ECMO Workshop ECMO and VAD implantation Prof. Tomaso Bottio Division of Cardiac Surgery (Director Prof. Gino gerosa) ECMO Extracorporeal membrane oxygena1on (ECMO) is a rescue therapy to support

More information

ECLS: A new frontier for refractory V.Fib and pulseless VT

ECLS: A new frontier for refractory V.Fib and pulseless VT ECLS: A new frontier for refractory V.Fib and pulseless VT Ernest L. Mazzaferri, Jr. MD, FACC September 15, 2017 Cardiovascular Emergencies: An exploration into the expansion of time-critical diagnosis

More information

Cardioplegia Circuit Products { CARDIOPLEGIA ADAPTERS}

Cardioplegia Circuit Products { CARDIOPLEGIA ADAPTERS} Cardioplegia Circuit Products { CARDIOPLEGIA ADAPTERS} Cardioplegia adapters are designed to permit customization of the cardioplegia circuit. Medtronic adapters can be used to connect multiple cardioplegia

More information

Kevin K. Nunnink Extracorporeal Membrane Oxygenation Program

Kevin K. Nunnink Extracorporeal Membrane Oxygenation Program PATIE NT I N FO R M ATI O N Kevin K. Nunnink Extracorporeal Membrane Oxygenation Program A family s guide to understanding this specialized treatment for cardiac and pulmonary complications Saint Luke

More information

Evolution of ECLS. 04/22/2016 Updated. AllinaHealthSystem. Minneapolis ECMO Early history. ELSO Member Centers

Evolution of ECLS. 04/22/2016 Updated. AllinaHealthSystem. Minneapolis ECMO Early history. ELSO Member Centers Evolution of ECLS Minneapolis 2016 Boston Children s Hospital Surgical Staff 1965 ECMO Early history Lab, 4 days ECC First cardiac case First newborn case(esperanza) 1965 1971 1972 1975 1980 First sucessful

More information

Understanding the Cardiopulmonary Bypass Machine and Its Tubing

Understanding the Cardiopulmonary Bypass Machine and Its Tubing Understanding the Cardiopulmonary Bypass Machine and Its Tubing Robert S. Leckie, MD Division of Cardiac Anesthesia, Beth Israel Deaconess Medical Center ABL 1/09 Reservoir Bucket This is a cartoon of

More information

Cardiac anaesthesia. Simon May

Cardiac anaesthesia. Simon May Cardiac anaesthesia Simon May Contents Cardiac: Principles of peri-operative management for cardiac surgery Cardiopulmonary bypass, cardioplegia and off pump cardiac surgery Cardiac disease and its implications

More information

12/19/2017. Learning Objectives. Mechanical Circulatory Support. Mechanical Aids to External Massage. Noninvasive Mechanical Support Devices

12/19/2017. Learning Objectives. Mechanical Circulatory Support. Mechanical Aids to External Massage. Noninvasive Mechanical Support Devices Learning Objectives Mechanical Circulatory Support Explain the indications, function, & complications for selected mechanical circulatory support devices Describe examples of ventricular assist devices

More information

9/17/2014. Good Morning! 14th Annual Western Kansas Respiratory Care Seminar. 14th Annual Western Kansas Respiratory Care Seminar 28th

9/17/2014. Good Morning! 14th Annual Western Kansas Respiratory Care Seminar. 14th Annual Western Kansas Respiratory Care Seminar 28th Good Morning! 14th Annual Western Kansas Respiratory Care Seminar Current Status of Extracorporeal Membrane Oxygenation (ECMO) in Infants and Adults Kelly D. Hedlund, MS, CCP Chief Perfusionist Michael

More information

ECPR: An emerging strategy for cardiac arrest

ECPR: An emerging strategy for cardiac arrest ECPR: An emerging strategy for cardiac arrest Steven Brooks MD MHSc FRCPC Associate Professor Department of Emergency Medicine, Queen s University November 2016 Conventional CPR is ineffective Conventional

More information

ECMO Extracorporeal Membrane Oxygenation

ECMO Extracorporeal Membrane Oxygenation ECMO Extracorporeal Membrane Oxygenation patienteducation.osumc.edu ECMO Table of Contents ECMO: Extracorporeal Membrane Oxygenation... 3 ECMO Treatment... 5 Care Team... 7 Discontinuing ECMO... 8 Notes,

More information

ECMO vs. CPB for Intraoperative Support: How do you Choose?

ECMO vs. CPB for Intraoperative Support: How do you Choose? ECMO vs. CPB for Intraoperative Support: How do you Choose? Shaf Keshavjee MD MSc FRCSC FACS Director, Toronto Lung Transplant Program Surgeon-in-Chief, University Health Network James Wallace McCutcheon

More information

Associated clinical guidelines/protocols: Comprehensive GOSH ECMO guidelines are available in the ECMO office.

Associated clinical guidelines/protocols: Comprehensive GOSH ECMO guidelines are available in the ECMO office. Disclaimer: The Great Ormond Street Paediatric Intensive Care Training Programme was developed in 2004 by the clinicians of that Institution, primarily for use within Great Ormond Street Hospital and the

More information

SHOCK AETIOLOGY OF SHOCK (1) Inadequate circulating blood volume ) Loss of Autonomic control of the vasculature (3) Impaired cardiac function

SHOCK AETIOLOGY OF SHOCK (1) Inadequate circulating blood volume ) Loss of Autonomic control of the vasculature (3) Impaired cardiac function SHOCK Shock is a condition in which the metabolic needs of the body are not met because of an inadequate cardiac output. If tissue perfusion can be restored in an expeditious fashion, cellular injury may

More information

Understanding the Pediatric Ventricular Assist Device

Understanding the Pediatric Ventricular Assist Device Understanding the Pediatric Ventricular Assist Device W. James Parks, MSc., MD Pediatric Cardiologist Assistant Professor of Pediatrics and Radiology Children s Healthcare of Atlanta Sibley Heart Center

More information

Complications of ECLS. Rajasekhar Malyala, MD Assistant Professor, Surgery University of Kentucky

Complications of ECLS. Rajasekhar Malyala, MD Assistant Professor, Surgery University of Kentucky Complications of ECLS Rajasekhar Malyala, MD Assistant Professor, Surgery University of Kentucky Faculty Disclosure No financial Disclosures Education Need/Practice Gap Recommendations and guidelines regarding

More information

A Study of Prior Cases

A Study of Prior Cases A Study of Prior Cases Clinical theme Sub theme Clinical situation/problem Clinical approach Outcome/Lesson Searchable Key word(s) 1 Cannulation Cannulae insertion The surgeon was trying to cannulate for

More information

Stayin Alive: Pediatric Advanced Life Support (PALS) Updated Guidelines

Stayin Alive: Pediatric Advanced Life Support (PALS) Updated Guidelines Stayin Alive: Pediatric Advanced Life Support (PALS) Updated Guidelines Margaret Oates, PharmD, BCPPS Pediatric Critical Care Specialist GSHP Summer Meeting July 16, 2016 Disclosures I have nothing to

More information

Post Resuscitation (ROSC) Care

Post Resuscitation (ROSC) Care Standard Operating Procedure 2.10 Post Resuscitation (ROSC) Care Position Responsible: Medical Director Approved: Clinical Governance Committee Related Documents: This document is the intellectual property

More information

ICU Volume 14 - Issue 1 - Spring Matrix

ICU Volume 14 - Issue 1 - Spring Matrix ICU Volume 14 - Issue 1 - Spring 2014 - Matrix The ECMO Retrieval Team Authors Alain Combes, MD Medical-Surgical Intensive Care Unit ican, Institute of Cardiometabolism and Nutrition Hôpital de la Pitié

More information

EACTS Adult Cardiac Database

EACTS Adult Cardiac Database EACTS Adult Cardiac Database Quality Improvement Programme List of changes to Version 2.0, 13 th Dec 2018, compared to version 1.0, 1 st May 2014. INTRODUCTORY NOTES This document s purpose is to list

More information

Refractory cardiac arrest

Refractory cardiac arrest Refractory cardiac arrest Claudio Sandroni Dept. of Anaesthesiology and Intensive Care Catholic University School of Medicine Rome Italy IRC Scientific Committee Conflicts of interest None Cardiac arrest:

More information

Update on Sudden Cardiac Death and Resuscitation

Update on Sudden Cardiac Death and Resuscitation Update on Sudden Cardiac Death and Resuscitation Ashish R. Panchal, MD, PhD Medical Director Center for Emergency Medical Services Assistant Professor Clinical Department of Emergency Medicine The Ohio

More information

Duct Dependant Congenital Heart Disease

Duct Dependant Congenital Heart Disease Children s Acute Transport Service Clinical Guidelines Duct Dependant Congenital Heart Disease Document Control Information Author CATS/NTS Author Position CC Transport Services Document Owner E. Polke

More information

Management of Respiratory Failure: The Surgical Perspective. When Traditional Respiratory Support Techniques fail. ARDS: Evidence Based Practice

Management of Respiratory Failure: The Surgical Perspective. When Traditional Respiratory Support Techniques fail. ARDS: Evidence Based Practice Critical Care Medicine and Trauma Management of Respiratory Failure: The Surgical Perspective Jasleen Kukreja, M.D. Division of Cardiothoracic Surgery University of California San Francisco When Traditional

More information

PROBLEM: Shock refractory VF/pVT BACKGROUND: Both in 2015 CoSTR. Amiodarone favoured.

PROBLEM: Shock refractory VF/pVT BACKGROUND: Both in 2015 CoSTR. Amiodarone favoured. Question Should AMIODARONE vs LIDOCAINE be used for adults with shock refractory VF/pVT PROBLEM: Shock refractory VF/pVT BACKGROUND: Both in 2015 CoSTR. Amiodarone favoured. OPTION: AMIODARONE plus standard

More information

Department of Surgery, Division of Cardiothoracic Surgery

Department of Surgery, Division of Cardiothoracic Surgery Review of In-Hospital and Out-of-Hospital Cardiac Arrests at a Tertiary Community Hospital for Potential ECPR Rescue Amanda Broderick 1, Jordan Williams 1, Alexandra Maryashina 1, & James Wu, MD 1 1 Department

More information

The Role of Mechanical Circulatory Support in Cardiogenic Shock: When to Utilize

The Role of Mechanical Circulatory Support in Cardiogenic Shock: When to Utilize The Role of Mechanical Circulatory Support in Cardiogenic Shock: Presented by Nancy Scroggins ACNP, CNS-CC CV Surgery ACNP Bayshore Medical Center The Role of Mechanical Circulatory Support in Cardiogenic

More information

GUIDELINE PHYSIOLOGY OF BIRTH ASPHYXIA

GUIDELINE PHYSIOLOGY OF BIRTH ASPHYXIA GUIDELINE PHYSIOLOGY OF BIRTH ASPHYXIA The newborn is not an adult, nor a child. In people of all ages, death can occur from a failure of breathing and / or circulation. The interventions required to aid

More information

Duct Dependant Congenital Heart Disease

Duct Dependant Congenital Heart Disease Children s Acute Transport Service Clinical Guidelines Duct Dependant Congenital Heart Disease This guideline has been agreed by both NTS & CATS Document Control Information Author CATS/NTS Author Position

More information

Management of Cardiac Arrest Based on : 2010 American Heart Association Guidelines

Management of Cardiac Arrest Based on : 2010 American Heart Association Guidelines Management of Cardiac Arrest Based on : 2010 American Heart Association Guidelines www.circ.ahajournals.org Elham Pishbin. M.D Assistant Professor of Emergency Medicine MUMS C H E S Advanced Life Support

More information

Extracorporeal Membrane Oxygenation for Severe Pediatric Respiratory Failure

Extracorporeal Membrane Oxygenation for Severe Pediatric Respiratory Failure Extracorporeal Membrane Oxygenation for Severe Pediatric Respiratory Failure John C Lin MD Introduction ECMO Basics Indications Pediatric ARDS Bridge to Lung Transplantation Other ECMO Transport Ventilator

More information

Don t let your patients turn blue! Isn t it about time you used etco 2?

Don t let your patients turn blue! Isn t it about time you used etco 2? Don t let your patients turn blue! Isn t it about time you used etco 2? American Association of Critical Care Nurses National Teaching Institute Expo Ed 2013 Susan Thibeault MS, CRNA, APRN, CCRN, EMT-P

More information

The Blue Baby. Network Stabilisation of the Term Infant Study Day 15 th March 2017 Joanna Behrsin

The Blue Baby. Network Stabilisation of the Term Infant Study Day 15 th March 2017 Joanna Behrsin The Blue Baby Network Stabilisation of the Term Infant Study Day 15 th March 2017 Joanna Behrsin Session Structure Definitions and assessment of cyanosis Causes of blue baby Structured approach to assessing

More information

Emergency Cardiac Care Guidelines 2015

Emergency Cardiac Care Guidelines 2015 Emergency Cardiac Care Guidelines 2015 VACEP 2016 William Brady, MD University of Virginia Guidelines 2015 Basic Life Support & Advanced Cardiac Life Support Acute Coronary Syndrome Pediatric Advanced

More information

Extracorporeal Life Support (ECLS) as a Bridge to Decision in Lung Transplantation

Extracorporeal Life Support (ECLS) as a Bridge to Decision in Lung Transplantation Extracorporeal Life Support (ECLS) as a Bridge to Decision in Lung Transplantation Gabriel Loor, MD Baylor St. Lukes Medical Center Surgical Director Lung Transplantation Co-chief Section of Adult Cardiac

More information

Outcomes From Severe ARDS Managed Without ECMO. Roy Brower, MD Johns Hopkins University Critical Care Canada Forum Toronto November 1, 2016

Outcomes From Severe ARDS Managed Without ECMO. Roy Brower, MD Johns Hopkins University Critical Care Canada Forum Toronto November 1, 2016 Outcomes From Severe ARDS Managed Without ECMO Roy Brower, MD Johns Hopkins University Critical Care Canada Forum Toronto November 1, 2016 Severe ARDS Berlin Definition 2012 P:F ratio 100 mm Hg Prevalence:

More information

WELCOME. Welcome to the Children s Hospital PICU (Pediatric Intensive Care Unit). We consider it a privilege to care for your child and your family.

WELCOME. Welcome to the Children s Hospital PICU (Pediatric Intensive Care Unit). We consider it a privilege to care for your child and your family. ECMO FAMILY GUIDE WELCOME Welcome to the Children s Hospital PICU (Pediatric Intensive Care Unit). We consider it a privilege to care for your child and your family. This book was created to give you the

More information

EXTRACORPOREAL LIFE SUPPORT FOR PROLONGED CARDIAC ARREST

EXTRACORPOREAL LIFE SUPPORT FOR PROLONGED CARDIAC ARREST EXTRACORPOREAL LIFE SUPPORT FOR PROLONGED CARDIAC ARREST Massimo MASSETTI Cardiac Surgery Department University of Sacred Heart, Gemelli Hospital Rome «No financial interest to declare» ESC CONGRESS 2012

More information

Ted Feldman, M.D., MSCAI FACC FESC

Ted Feldman, M.D., MSCAI FACC FESC Support Technologies and High Risk Intervention Patient Selection: When Not to Use Them Ted Feldman, M.D., MSCAI FACC FESC Evanston Hospital SCAI Fall Fellows Course Las Vegas December 7-10 th, 2014 Ted

More information

Extracorporeal Life Support Organization (ELSO) General Guidelines for all ECLS Cases

Extracorporeal Life Support Organization (ELSO) General Guidelines for all ECLS Cases Extracorporeal Life Support Organization (ELSO) General Guidelines for all ECLS Cases Introduction This guideline describes prolonged extracorporeal life support (ECLS, ECMO). Related guidelines with more

More information

Victorian Ambulance Cardiac Arrest Registry (VACAR)

Victorian Ambulance Cardiac Arrest Registry (VACAR) Victorian Ambulance Cardiac Arrest Registry (VACAR) Dr Karen Smith (PhD) VACAR Chair Manager Research and Evaluation Ambulance Victoria Smith K, Bray J, Barnes V, Lodder M, Cameron P, Bernard S and Currell

More information

Intra-operative Effects of Cardiac Surgery Influence on Post-operative care. Richard A Perryman

Intra-operative Effects of Cardiac Surgery Influence on Post-operative care. Richard A Perryman Intra-operative Effects of Cardiac Surgery Influence on Post-operative care Richard A Perryman Intra-operative Effects of Cardiac Surgery Cardiopulmonary Bypass Hypothermia Cannulation events Myocardial

More information

Index. Note: Page numbers of article titles are in boldface type.

Index. Note: Page numbers of article titles are in boldface type. Note: Page numbers of article titles are in boldface type. A Abdomen, and aorta, as causes of shock, point-of-care ultrasonography in assessment of, 915 917 Abdominal compartment syndrome, trauma patient

More information

Extracorporeal Life Support Organization (ELSO) General Guidelines for all ECLS Cases August, 2017

Extracorporeal Life Support Organization (ELSO) General Guidelines for all ECLS Cases August, 2017 Extracorporeal Life Support Organization (ELSO) Introduction General Guidelines for all ECLS Cases August, 2017 This guideline describes prolonged extracorporeal life support (ECLS, ECMO), applicable to

More information

Running head: USE OF COAGULATION ALGORITHM AT THE BEDSIDE DURING 1

Running head: USE OF COAGULATION ALGORITHM AT THE BEDSIDE DURING 1 Running head: USE OF COAGULATION ALGORITHM AT THE BEDSIDE DURING 1 Use of Coagulation Algorithm at the Bedside During Extra Corporeal Membrane Oxygenation in Neonatal and Pediatric Patients Kimberly Goracke

More information

ECMO for Severe Hypoxemic Respiratory Failure: Pro-Con Debate. Carolyn Calfee, MD MAS Mark Eisner, MD MPH

ECMO for Severe Hypoxemic Respiratory Failure: Pro-Con Debate. Carolyn Calfee, MD MAS Mark Eisner, MD MPH ECMO for Severe Hypoxemic Respiratory Failure: Pro-Con Debate Carolyn Calfee, MD MAS Mark Eisner, MD MPH June 3, 2010 Case Presentation Setting: Community hospital, November 2009 29 year old woman with

More information

² C Y E N G R E M E ssignac Cardiac Arrest Resuscitation Device uob

² C Y E N G R E M E ssignac Cardiac Arrest Resuscitation Device uob E M E R G E N C Y Boussignac Cardiac Arrest Resuscitation Device ² What is b-card? b-card Boussignac Cardiac Arrest Resuscitation Device has been designed specifically for the treatment of cardiac arrest.

More information