Episode 9 - The rEVOLUTION of ECMO | Trauma ICU Rounds

This podcast explores the use of Extracorporeal Membrane Oxygenation (ECMO) in critical care, focusing on its evolution, different modes, and expanding indications. Dr. Peyman Benharash, a cardiothoracic surgeon at UCLA, details the rise of ECMO from the 1970s to its mainstream adoption during the H1N1 pandemic, highlighting key trials like the CSER and EOLIA trials. The discussion covers the nuances between veno-arterial (VA) and veno-venous (VV) ECMO, emphasizing patient selection, cannulation techniques, and the importance of early intervention to prevent lung injury. Dr. Benharash also addresses the expanding role of ECMO in conditions beyond ARDS, such as status asthmaticus and hypothermia, as well as its potential application in trauma care and the challenges of regionalizing ECMO services.

Outlines

Part 1: History and Clinical Evidence

Part 2: Modes and Clinical Indications

Part 3: Logistics and Retrieval Systems

Part 4: Cannulation and Technical Procedures

Part 5: eCPR and Emergency Protocols

Part 6: Patient Management and Weaning

Part 7: Anticoagulation and Organ Complications

Part 8: Future Trends and Pandemic Insights

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Episode 9 - The rEVOLUTION of ECMO

Trauma ICU Rounds

Part 1: History and Clinical Evidence

00:12ECMO's Rise: From 1970s Experiment to Modern Organ Support

ECMO's Rise: From 1970s Experiment to Modern Organ Support

02:13ECMO's Evolving Role: Insights from the CSER and EOLIA Trials

ECMO's Evolving Role: Insights from the CSER and EOLIA Trials

Part 2: Modes and Clinical Indications

05:31ECMO vs. Cardiopulmonary Bypass: Modes, Types, and Key Differences

ECMO vs. Cardiopulmonary Bypass: Modes, Types, and Key Differences

07:48VV vs. VA ECMO: Determining the Need for Circulatory Support

VV vs. VA ECMO: Determining the Need for Circulatory Support

09:36VA ECMO Catheter Placement, Timing, and Contraindications

VA ECMO Catheter Placement, Timing, and Contraindications

12:25Expanding ECMO Indications: Hypothermia and Status Asthmaticus

Expanding ECMO Indications: Hypothermia and Status Asthmaticus

14:50ECMO for Periprocedural Support and Retrohepatic Vena Cava Injuries

ECMO for Periprocedural Support and Retrohepatic Vena Cava Injuries

Part 3: Logistics and Retrieval Systems

17:08Regionalizing ECMO Care: Centralization and Retrieval Models

Regionalizing ECMO Care: Centralization and Retrieval Models

19:14ECMO Retrieval Process: Team Activation and Transport Logistics

ECMO Retrieval Process: Team Activation and Transport Logistics

Part 4: Cannulation and Technical Procedures

21:16ECMO Cannulation: Expertise, Safety, and Specialization

ECMO Cannulation: Expertise, Safety, and Specialization

23:05Percutaneous Cannulation and Distal Perfusion Catheters

Percutaneous Cannulation and Distal Perfusion Catheters

25:32Distal Perfusion Catheters and VA vs. VV ECMO Intricacies

Distal Perfusion Catheters and VA vs. VV ECMO Intricacies

Part 5: eCPR and Emergency Protocols

27:30Cardiac Output, eCPR, and Refractory Arrhythmias

Cardiac Output, eCPR, and Refractory Arrhythmias

29:31eCPR Guidelines, Collaboration, and Neurologic Outcomes

eCPR Guidelines, Collaboration, and Neurologic Outcomes

31:41Hypothermia and Neurologic Recovery in eCPR

Hypothermia and Neurologic Recovery in eCPR

33:10ECMO Cannulation During CPR: Access Sites and Challenges

ECMO Cannulation During CPR: Access Sites and Challenges

35:21Avalon Catheter Considerations for ECMO

Avalon Catheter Considerations for ECMO

Part 6: Patient Management and Weaning

37:51Day-to-Day Considerations for Patients on ECMO

Day-to-Day Considerations for Patients on ECMO

39:56Monitoring and Managing ECMO Circuits: VV vs. VA

Monitoring and Managing ECMO Circuits: VV vs. VA

42:07Harlequin Syndrome and VAV ECMO

Harlequin Syndrome and VAV ECMO

43:31Weaning Patients Off ECMO: VV Considerations

Weaning Patients Off ECMO: VV Considerations

45:25Weaning Patients Off ECMO: VA Considerations and Ventricular Support

Weaning Patients Off ECMO: VA Considerations and Ventricular Support

47:25Ventricular Distension, Inotropic Support, and Vasopressor Preferences

Ventricular Distension, Inotropic Support, and Vasopressor Preferences

Part 7: Anticoagulation and Organ Complications

49:17Balancing Clot Risk and Anticoagulation Strategies

Balancing Clot Risk and Anticoagulation Strategies

51:35Anticoagulation Monitoring and Choice of Anticoagulant

Anticoagulation Monitoring and Choice of Anticoagulant

53:45Renal Failure and Multi-Organ Considerations on ECMO

Renal Failure and Multi-Organ Considerations on ECMO

55:05ECMO's Impact on Organ Systems: Brain, Liver, and Intestinal Tract

ECMO's Impact on Organ Systems: Brain, Liver, and Intestinal Tract

Part 8: Future Trends and Pandemic Insights

57:22ECMO 2.0: Balancing Technology, Cost, and Expertise

ECMO 2.0: Balancing Technology, Cost, and Expertise

59:32Cost Considerations and Technology Choices in ECMO

Cost Considerations and Technology Choices in ECMO

1:01:21ECMO in COVID-19: Evolving Insights and Guidelines

ECMO in COVID-19: Evolving Insights and Guidelines

1:04:24ECMO Cannulation During the Pandemic: Safety Strategies

ECMO Cannulation During the Pandemic: Safety Strategies

1:06:46ECMO's Future: Early Consideration and Refractory Illnesses

ECMO's Future: Early Consideration and Refractory Illnesses