Episode 5: Cardiogenic shock and ECMO with Brendan Riordan

This podcast episode addresses the complexities of managing a patient with cardiogenic shock, focusing on the use of mechanical circulatory support. Brendan Riordan, a cardiothoracic critical care PA, joins the hosts to discuss a hypothetical case involving a 45-year-old male with a left main lesion. Riordan details the stepwise approach to escalating support, from initial norepinephrine administration and Impella CP placement to the decision-making process behind initiating VA ECMO for biventricular support. He explains VA ECMO settings, including flow targets based on BSA, and the importance of monitoring for complications like regional hypoxemia and limb ischemia, highlighting the necessity of preemptive anti-grade perfusion catheters. The conversation further explores weaning strategies, emphasizing echo-guided assessments and a protocolized approach to reduce support while monitoring LV function.

Outlines

Part 1: Introduction, Initial Scenario

Part 2: Mechanical Support, Device Selection

Part 3: Clinical Management, Monitoring

Part 4: Weaning, Risk Assessment

Sign in to continue reading, translating and more.

Continue

Critical Care Scenarios

Part 1: Introduction, Initial Scenario

Introduction to Cardiothoracic Critical Care and Initial Patient Scenario

Initial Assessment and Plan: Protected PCI with Impella Support

Part 2: Mechanical Support, Device Selection

Impella Device Overview and Rationale for Mechanical Support

Escalating Support: Considering VA ECMO for Biventricular Failure

VA ECMO Initial Settings and Hemodynamic Considerations

Part 3: Clinical Management, Monitoring

Anticoagulation Strategies and Heparin Management on ECMO

Managing Hypertension, Assessing Recovery, and Regional Hypoxemia

Differentiating and Managing Regional vs. Global Hypoxemia

Daily Management of VA ECMO: Circuit Monitoring and Extremity Ischemia

Swan-Ganz Catheters and Hemodynamic Monitoring on ECMO

Part 4: Weaning, Risk Assessment

Weaning Strategies for Impella and ECMO: Echo Guidance and OR Decannulation

Balancing Mechanical Support Benefits and Risks: A Complex Decision

Episode 5: Cardiogenic shock and ECMO with Brendan Riordan

Critical Care Scenarios

Part 1: Introduction, Initial Scenario

00:05Introduction to Cardiothoracic Critical Care and Initial Patient Scenario

Introduction to Cardiothoracic Critical Care and Initial Patient Scenario

02:11Initial Assessment and Plan: Protected PCI with Impella Support

Initial Assessment and Plan: Protected PCI with Impella Support

Part 2: Mechanical Support, Device Selection

04:33Impella Device Overview and Rationale for Mechanical Support

Impella Device Overview and Rationale for Mechanical Support

06:35Escalating Support: Considering VA ECMO for Biventricular Failure

Escalating Support: Considering VA ECMO for Biventricular Failure

11:07VA ECMO Initial Settings and Hemodynamic Considerations

VA ECMO Initial Settings and Hemodynamic Considerations

Part 3: Clinical Management, Monitoring

16:54Anticoagulation Strategies and Heparin Management on ECMO

Anticoagulation Strategies and Heparin Management on ECMO

20:23Managing Hypertension, Assessing Recovery, and Regional Hypoxemia

Managing Hypertension, Assessing Recovery, and Regional Hypoxemia

24:49Differentiating and Managing Regional vs. Global Hypoxemia

Differentiating and Managing Regional vs. Global Hypoxemia

29:42Daily Management of VA ECMO: Circuit Monitoring and Extremity Ischemia

Daily Management of VA ECMO: Circuit Monitoring and Extremity Ischemia

37:38Swan-Ganz Catheters and Hemodynamic Monitoring on ECMO

Swan-Ganz Catheters and Hemodynamic Monitoring on ECMO

Part 4: Weaning, Risk Assessment

41:12Weaning Strategies for Impella and ECMO: Echo Guidance and OR Decannulation

Weaning Strategies for Impella and ECMO: Echo Guidance and OR Decannulation

44:18Balancing Mechanical Support Benefits and Risks: A Complex Decision

Balancing Mechanical Support Benefits and Risks: A Complex Decision