EDECMO 39: Who Do We Put On ECMO? – New Data on Prognostics
In 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 Singer out of the UK published a paper utilizing cardiac arrest data from the PRIMED trial. He showed that even patients with all the advantageous characteristics of traditional ECMO inclusion criteria had poor survivals once they have had g30 minutes of chest compressions. With many ECMO studies having average arrest to initiation times of g 60 minutes, Josh’s paper certainly makes us view favorably the 30% survival outcomes that we are seeing worldwide. This in no way substitutes for a randomized trial but does offer some guidance on what the expected survival of a patient with a witnessed arrest, short low flow times, and age
