EDECMO 20 – The Golden Hour & the Rule of 3’s: Optimizing the Critical First Hour on Heart-Lung Bypass

This podcast episode focuses on optimizing the first critical hour of putting a patient on heart-lung bypass (ECMO). The hosts detail the ECMO circuit setup, emphasizing the importance of priming the circuit with a heparinized Isolite solution and removing air to prevent air embolism. They stress three key steps before initiating bypass: heparinizing the patient, ensuring the oxygen source is attached and working, and confirming no open central lines are present. Post-initiation, the hosts advise confirming the arterial line shows bright red blood and the venous line shows dark red, securing cannulas with sutures, and closing the recirculation bridge. Optimizing blood flow, arterial blood gas analysis, and systemic vascular resistance are also crucial for hemodynamic optimization, with guidance on adjusting flow rates, sweep gas, and vasopressors.