lystn

What are the indications for ECMO beyond ARDS and refractory cardiogenic shock? In which patients should we consider eCPR and is this the new standard of care for patients sustaining out-of-hospital cardiac arrest? Finally, how do I work towards safely and efficiently weaning my patient from VV or VA ECMO?  These are just a few of the questions that we address on Rounds with our guest faculty member and Director of the UCLA Adult ECMO Program, Dr. Peyman Benharash. In this comprehensive review of ECMO we also explore the regionalization of ECMO care here in Los Angeles County, as well as the day-to-day considerations that you want to bear in mind when assessing and caring for your patients requiring extracorporeal life support. Learning ObjectivesBy the end of rounds you should be able to: 1. Understand the indications a contraindications to VV and VA ECMO support 2. Describe the basic components of an ECMO circuit 3. Describe the role of eCPR in the management of adult patients with out-of-hospital cardiac arrest 4. Discuss key management strategies to safely wean patients from ECMO 5. Describe common complications of ECMO and strategies to mitigate them Take Home Points ECMO is time-sensitive, therefore, early and safe cannulation is an important determinant of outcome ECMO is a bridge to therapy Use of scoring systems like the Murray Score may be useful to stratify the severity of ARDS among patients being considered for VV ECMO support The indications for ECMO are expanding to include technically challenging operative cases eCPR is a promising therapy for patients presenting to an ECMO center of excellence with refractory VF/VT cardiac arrest  ECMO therapy, particularly VA ECMO, may affect virtually organ system The potential role of ECMO therapy during the current COVID-19 pandemic remains to be defined Time Stamps 00:12 Introduction 01:16 Overview of Rounds  02:13 The rise of ECMO  02:46 CESAR a EOLIA trials summarized  05:40 Venovenous (VV) vs. Venoarterial (VA) ECMO 08:24 How to decide whether or not to place a patient on VA ECMO?    10:33 Timing a indications for ECMO support 11:38 Murray Score explained 12:24 Contraindications a patient selection for VV a VA ECMO 13:56 Expanding indications for ECMO 15:23 ECMO in the Setting of Trauma: Pneumonectomy a Retrohepatic IVC injuries 17:45 Regionalization of ECMO in Los Angeles County 21:52 Who should be cannulating? 23:22 Approach to cannulation 24:50 Distal perfusion catheters for VA ECMO 26:10 Differences between VV a VA ECMO 28:24 The W5H of eCPR 34:26 Considerations for access for VV ECMO 35:53 Avalon catheter  37:51 VV versus VA ECMO circuits/set-up explained 43:30 Getting your patient off of ECMO a other key considerations 48:56 Vasopressor a inotropic therapy during VA ECMO 50:31 Virchow’s triad,  antithrombotic therapy a bleeding on ECMO 54:30 AKI, end-organ dysfunction a the daily assessment of patients on ECMO 57:22 ECMO 2.0 a the role of evolving technologies 61:20 Role of ECMO during the COVID-19 pandemic  66:45 Take-home points 68:38 Outro