Reanimate Conference

Hands-On ECMO Training

  • About
  • Faculty
  • Schedule
  • FAQ
  • Contact
  • Register

Post-Pump Critical Care

Review Articles

  • Best Post-Pump Crit Care Paper
  • Management_of_Peripheral_Venoarterial ECMO
  • Troubleshooting Adult ECMO

Monitoring

Monitoring_during_extracorporeal_membrane.98836

Monitoring of the Adult Patient on Venoarterial Extracorporeal Membrane Oxygenation

Debate over whether these pts benefit from PAC

Differential Hypoxemia

from Scancrit

Flow

Classically in Card. Shock, shooting for 60 ml/kg/min; in ECPR we will tolerate lower flows.

Shooting for SvO2 >=65-70%

Both fluids and vasoconstriction allow increased flow (SHOCK, Vol. 51, No. 5, pp. 650–658, 2019)

Anticoagulation

Ideally before start INR<2, PLT>50, Fibrinogen>150

STC uses PTT 45-55 for non-clot, 60-80 for clotted pt

if Heparin dose > 25 Units/kg/hr and still not therapeutic, measure ATIII

if ATIII activity <60%, consider admin

((120-ATIII)*Kg)/1.4

check 20 min and 12 hours after admin

Chattering/Drainage Insufficiency

Crit Care 2020;24:151

Vasoconstriction and Volume Expansion

THE EFFECTS OF VASOCONSTRICTION AND VOLUME EXPANSION ON

 

LV Distension (Must have Ejection of LV)

aortic root blood stasis will occur despite heparin

must see aortic valve opening

if a clot has formed, then the goal is to try to stop ejection

Hireche-Chikaoui (Crit Care Med. 2018;46(5):e459-e464. [PubMed])

flow continues even if heart is not beating from Bronchial and Thebesian veins

Best review of LV Distension and Solutions

Higher Flow impairs LV Function (J Transl Med (2015) 13:266)

from Circ Heart Fail. 2018;11:e004905. DOI: 10.1161/CIRCHEARTFAILURE.118.004905

LA-VA ECMO (mulstistage placed perc. through atrial septum)

Transaortic catheter left ventricle venting–may be insufficient drainage

In the Columbia Study (on actual patients rather than simulation modelling) Impella was maangement for LVD++ (ASAIO J. 2017 May/Jun;63(3):257-265. doi: 10.1097/MAT.0000000000000553)

 

Recent Retrospective Study shows association with better outcomes with LV offloading in cardiogenic shock

  • lv distension and unloading
  • Left Ventricular Distension in Veno-arterial Extracorporeal
  • Left Ventricular Unloading During Veno-Arterial ECMO

Labs

from ALfred

LDH for hemolysis

Hyperoxia

Associated with worse outcomes [10.1016/j.jemermed.2022.05.018]

Cardiogenic Shock

Management of Card Shock

Management_of_Peripheral_Venoarterial.95910

Join the Mailing List




Contact Us for More Information

Get in Touch

Resources for Participants

Participants Page

Supported By…

Our Exhibitors

CME Brought to You by

GWU

See Full CME Info

Connect with Us on Social Media

  • Facebook
  • Twitter

Sign-Up ASAP

Register Now

All Rights Reserved; EDECMO LLC 2015-. This site represents our opinions only. See here for full disclaimer.