Episode 2 – The Three Stages of ECPR

This podcast episode focuses on the three stages of initiating Extracorporeal Membrane Oxygenation (ECMO) in emergency departments, particularly for patients experiencing cardiac arrest. The first stage involves inserting femoral venous and arterial lines, ideally with ultrasound guidance, emphasizing the advantage of placing the arterial line while the patient still has a pulse. The second stage details the dilation process to accommodate larger ECMO catheters, highlighting the risks of retroperitoneal injury and the importance of careful technique. The final stage covers turning on the ECMO pump, ensuring proper priming, and observing blood color changes to confirm functionality, with a target flow rate of four to five liters. The speakers underscore that ECMO initiation typically occurs after failed ACLS, positioning it as a critical intervention when other resuscitation efforts have been exhausted.