Episode 33: ECMO with Dr. Rosanne Sheinberg

This podcast explores the use of Extracorporeal Membrane Oxygenation (ECMO) as a modified cardiopulmonary bypass for prolonged circulatory support. Dr. Rosanne Sheinberg clarifies ECMO's role as a supportive, not curative, therapy, facilitating recovery from cardiac or pulmonary damage. The discussion covers the differences between VV ECMO for respiratory support and VA ECMO for combined respiratory and hemodynamic support, detailing cannula placement and goals for each. Indications for ECMO include severe ARDS, cardiac failure, and procedural support for high-risk interventions, while contraindications involve conditions incompatible with recovery. Management strategies involve adjusting ECMO flow rates to meet metabolic needs, monitoring organ perfusion, and addressing complications like bleeding, thrombosis, and neurologic issues.

Outlines

Part 1: Introduction, Basics

Part 2: Types, Indications

Part 3: Contraindications, Risks

Part 4: Clinical Management, Perfusion

Part 5: Troubleshooting, Complications

Part 6: Systemic Effects, Organ Support

Part 7: Technical Challenges, Syndromes

Part 8: Mobilization, Weaning

Part 9: Settings, Outcomes

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Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

Part 1: Introduction, Basics

FIGS Scrubs: Durable, Comfortable Healthcare Apparel with Antimicrobial Properties

Introduction to ECMO: Modified Cardiopulmonary Bypass for Prolonged Cardiopulmonary Support

Goals of ECMO Support: Cardiopulmonary Support, Blood Flow, and Oxygenation

Part 2: Types, Indications

VA ECMO: Complete Respiratory and Hemodynamic Support Indications

VA ECMO Indications: Cardiac Failure, Cardiogenic Shock, and Procedural Support

Part 3: Contraindications, Risks

ECMO Contraindications: Pre-existing Conditions and Technical Considerations

Balancing Risks: Anticoagulation, Thrombosis, and ECMO Initiation Challenges

Part 4: Clinical Management, Perfusion

Managing Blood Pressure on ECMO: Arterial Line Tracings and Pulsatility

Hypertension, Hypotension, and Flow Management on ECMO

Cannula Sizes, Metabolic Needs, and Assessing Organ Perfusion

Oxygen Delivery, Metabolic Demands, and Managing Poor Perfusion

Part 5: Troubleshooting, Complications

Troubleshooting Decreased Flow: Hypovolemia, Cannula Malposition, and Thrombosis

Peripheral VA ECMO: Non-Physiologic Flow and Left Ventricular Distension

Decompressing the Left Ventricle and Ventilator Management on ECMO

Part 6: Systemic Effects, Organ Support

Avoiding Adelectrauma and Managing the Renal System on ECMO

Renal Insufficiency, Dialysis, and Neurological Complications on ECMO

Infection Risks and Hematologic Considerations on ECMO

HIT Diagnosis and Main Complications of ECMO

Part 7: Technical Challenges, Syndromes

Bleeding, Thrombosis, and Membrane Oxygenator Lifespan

HIT, Thrombus, and Neurologic Complications on ECMO

Harlequin Syndrome and Monitoring Arterial Oxygenation

Cannula-Related Complications and Recirculation in VV ECMO

Understanding Recirculation and Factors Affecting It

Strategies to Decrease Recirculation and Other Complications

Part 8: Mobilization, Weaning

Balancing Mobilization and Cannula Dislodgement Risks

Weaning off ECMO: VV and VA Approaches

Decannulation and Maximizing Cardiac Function

Part 9: Settings, Outcomes

Adjusting ECMO Settings and Understanding Circuit Configurations

ECMO Effectiveness and Survival Rates

Episode 33: ECMO with Dr. Rosanne Sheinberg

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

Part 1: Introduction, Basics

00:00FIGS Scrubs: Durable, Comfortable Healthcare Apparel with Antimicrobial Properties

FIGS Scrubs: Durable, Comfortable Healthcare Apparel with Antimicrobial Properties

01:01Introduction to ECMO: Modified Cardiopulmonary Bypass for Prolonged Cardiopulmonary Support

Introduction to ECMO: Modified Cardiopulmonary Bypass for Prolonged Cardiopulmonary Support

04:57Goals of ECMO Support: Cardiopulmonary Support, Blood Flow, and Oxygenation

Goals of ECMO Support: Cardiopulmonary Support, Blood Flow, and Oxygenation

Part 2: Types, Indications

07:41VA ECMO: Complete Respiratory and Hemodynamic Support Indications

VA ECMO: Complete Respiratory and Hemodynamic Support Indications

10:34VA ECMO Indications: Cardiac Failure, Cardiogenic Shock, and Procedural Support

VA ECMO Indications: Cardiac Failure, Cardiogenic Shock, and Procedural Support

Part 3: Contraindications, Risks

12:49ECMO Contraindications: Pre-existing Conditions and Technical Considerations

ECMO Contraindications: Pre-existing Conditions and Technical Considerations

15:37Balancing Risks: Anticoagulation, Thrombosis, and ECMO Initiation Challenges

Balancing Risks: Anticoagulation, Thrombosis, and ECMO Initiation Challenges

Part 4: Clinical Management, Perfusion

17:39Managing Blood Pressure on ECMO: Arterial Line Tracings and Pulsatility

Managing Blood Pressure on ECMO: Arterial Line Tracings and Pulsatility

19:39Hypertension, Hypotension, and Flow Management on ECMO

Hypertension, Hypotension, and Flow Management on ECMO

21:23Cannula Sizes, Metabolic Needs, and Assessing Organ Perfusion

Cannula Sizes, Metabolic Needs, and Assessing Organ Perfusion

23:52Oxygen Delivery, Metabolic Demands, and Managing Poor Perfusion

Oxygen Delivery, Metabolic Demands, and Managing Poor Perfusion

Part 5: Troubleshooting, Complications

26:07Troubleshooting Decreased Flow: Hypovolemia, Cannula Malposition, and Thrombosis

Troubleshooting Decreased Flow: Hypovolemia, Cannula Malposition, and Thrombosis

28:31Peripheral VA ECMO: Non-Physiologic Flow and Left Ventricular Distension

Peripheral VA ECMO: Non-Physiologic Flow and Left Ventricular Distension

30:23Decompressing the Left Ventricle and Ventilator Management on ECMO

Decompressing the Left Ventricle and Ventilator Management on ECMO

Part 6: Systemic Effects, Organ Support

32:34Avoiding Adelectrauma and Managing the Renal System on ECMO

Avoiding Adelectrauma and Managing the Renal System on ECMO

34:23Renal Insufficiency, Dialysis, and Neurological Complications on ECMO

Renal Insufficiency, Dialysis, and Neurological Complications on ECMO

36:28Infection Risks and Hematologic Considerations on ECMO

Infection Risks and Hematologic Considerations on ECMO

38:41HIT Diagnosis and Main Complications of ECMO

HIT Diagnosis and Main Complications of ECMO

Part 7: Technical Challenges, Syndromes

40:25Bleeding, Thrombosis, and Membrane Oxygenator Lifespan

Bleeding, Thrombosis, and Membrane Oxygenator Lifespan

42:27HIT, Thrombus, and Neurologic Complications on ECMO

HIT, Thrombus, and Neurologic Complications on ECMO

44:05Harlequin Syndrome and Monitoring Arterial Oxygenation

Harlequin Syndrome and Monitoring Arterial Oxygenation

46:13Cannula-Related Complications and Recirculation in VV ECMO

Cannula-Related Complications and Recirculation in VV ECMO

47:16Understanding Recirculation and Factors Affecting It

Understanding Recirculation and Factors Affecting It

49:04Strategies to Decrease Recirculation and Other Complications

Strategies to Decrease Recirculation and Other Complications

Part 8: Mobilization, Weaning

50:33Balancing Mobilization and Cannula Dislodgement Risks

Balancing Mobilization and Cannula Dislodgement Risks

52:13Weaning off ECMO: VV and VA Approaches

Weaning off ECMO: VV and VA Approaches

54:01Decannulation and Maximizing Cardiac Function

Decannulation and Maximizing Cardiac Function

Part 9: Settings, Outcomes

55:21Adjusting ECMO Settings and Understanding Circuit Configurations

Adjusting ECMO Settings and Understanding Circuit Configurations

57:04ECMO Effectiveness and Survival Rates

ECMO Effectiveness and Survival Rates