60: ECPR 2.0 with Scott Weingart

The podcast explores the distinctions between ECMO/eCPR 1.0 and a proposed ECMO/eCPR 2.0, particularly in the context of out-of-hospital cardiac arrest versus cardiogenic shock. Scott Weingart argues that eCPR 1.0 outcomes, often dismal due to outdated equipment and patient selection (patients with already compromised hearts), shouldn't dictate perceptions of modern eCPR. He outlines key differences, including patient selection (prioritizing those with previously healthy hearts), cannulation techniques (emphasizing ultrasound-guided percutaneous placement), and post-pump critical care (advocating for mandatory leg perfusion and lower anticoagulation goals). Weingart highlights the importance of avoiding iatrogenic injuries and tailoring management to the vasodilatory state of post-arrest patients, suggesting lower flow goals and cautious use of vasopressors to balance systemic perfusion with the need for LV ejection. The discussion underscores the necessity of delaying cardiac and neurological prognostication, and stresses the importance of a cohesive care team.