CV-EMCrit Wee - Electrical Storm: Surviving the Storm Part II - Storm on VA-ECMO

This episode addresses the complexities of managing electrical storms in patients already on VA-ECMO, particularly cardiovascular ICU patients who may have been placed on ECMO for reasons other than electrical storm, such as post-cardiac surgery complications or end-stage cardiomyopathy. The discussion emphasizes identifying nuanced triggers for electrical storm in this population, including electrolyte imbalances, ischemia, and drug-related issues, as well as the VA-ECMO itself potentially contributing to the problem through increased afterload and LV distension. The speakers explore antiarrhythmic usage, highlighting the need for potentially higher doses of lipophilic drugs like amiodarone and lidocaine due to increased volume of distribution and sequestration in the ECMO circuit. They also discuss the use of epicardial wires for overdrive pacing and considerations for stellate ganglion blocks, defibrillation, and catheter ablation in VA-ECMO patients.