ECPR

The podcast explores the use of Extracorporeal Cardiopulmonary Resuscitation (ECPR) in critical care medicine, focusing on its application during refractory cardiac arrest. Dr. Adam Green, an intensivist at Cooper University Healthcare, explains ECPR's role in supporting circulation and oxygenation when conventional CPR fails. He highlights the importance of patient selection, emphasizing that ECPR is most effective for individuals with reversible conditions like acute MI or pulmonary embolism, and the necessity of immediate CPR with witnessed arrest. Dr. Green also shares insights on managing potential complications such as limb ischemia and North-South syndrome, as well as a moving case about organ donation.

Outlines

Part 1: Introduction, Definitions

Part 2: Selection, Literature, Contraindications

Part 3: Logistics, Initiation, Access

Part 4: Post-Cannulation, Complications

Part 5: Weaning, Prognosis, Ethics

Part 6: Expertise, Research, Future

Part 7: Final Advice, Closing

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Critical Matters

Part 1: Introduction, Definitions

Introduction to ECPR: A Growing Interest in Critical Care Medicine

Defining ECPR: ECMO Support During Refractory Cardiac Arrest

ECPR Criteria: Distinctions Between In-Hospital and Out-of-Hospital Cardiac Arrest

Key Terms in ECPR: Refractory, No Flow Time, and Low Flow Time

Part 2: Selection, Literature, Contraindications

ECPR Literature and Guidelines: Patient Selection is Key

Ideal ECPR Patient: Reversible Etiology and High-Quality CPR

ECPR Contraindications: Absolute vs. Relative Considerations

ECPR for Drug Overdoses: Social Support and Patient History

Part 3: Logistics, Initiation, Access

Initiating ECPR: Team Roles, Location, and Surrogate Consent

ECPR Logistics: Location, Timing, and Cannulation Cutoffs

Vascular Access for ECPR: Femoral-Femoral Cannulation

Part 4: Post-Cannulation, Complications

Post-Cannulation Management: Restoring Perfusion and Coronary Pressure

Post-ECPR Management: Identifying Cause and Monitoring Complications

Understanding North-South Syndrome: Cerebral Hypoxemia

Managing LV Ballooning and Other ECPR Complications

Part 5: Weaning, Prognosis, Ethics

Weaning ECPR: Ramp Trials and Cardiac Function Assessment

Unfavorable ECPR Trajectories: Family Communication and Consent

Neuroprognostication and ECPR Run Duration

Part 6: Expertise, Research, Future

Avoiding Pitfalls: Teamwork and Patient Selection

Building ECPR Expertise: Circuit Familiarity and Questioning Dogmas

ECPR Research and the Power of Organ Donation

Part 7: Final Advice, Closing

Influential Books: "Perfect Predator" and Succinylcholine Reconsideration

The Value of Availability: Advice for Intensivists

Closing Remarks

ECPR

Critical Matters

Part 1: Introduction, Definitions

00:05Introduction to ECPR: A Growing Interest in Critical Care Medicine

Introduction to ECPR: A Growing Interest in Critical Care Medicine

02:03Defining ECPR: ECMO Support During Refractory Cardiac Arrest

Defining ECPR: ECMO Support During Refractory Cardiac Arrest

05:05ECPR Criteria: Distinctions Between In-Hospital and Out-of-Hospital Cardiac Arrest

ECPR Criteria: Distinctions Between In-Hospital and Out-of-Hospital Cardiac Arrest

07:29Key Terms in ECPR: Refractory, No Flow Time, and Low Flow Time

Key Terms in ECPR: Refractory, No Flow Time, and Low Flow Time

Part 2: Selection, Literature, Contraindications

09:15ECPR Literature and Guidelines: Patient Selection is Key

ECPR Literature and Guidelines: Patient Selection is Key

12:24Ideal ECPR Patient: Reversible Etiology and High-Quality CPR

Ideal ECPR Patient: Reversible Etiology and High-Quality CPR

14:51ECPR Contraindications: Absolute vs. Relative Considerations

ECPR Contraindications: Absolute vs. Relative Considerations

17:26ECPR for Drug Overdoses: Social Support and Patient History

ECPR for Drug Overdoses: Social Support and Patient History

Part 3: Logistics, Initiation, Access

20:05Initiating ECPR: Team Roles, Location, and Surrogate Consent

Initiating ECPR: Team Roles, Location, and Surrogate Consent

23:01ECPR Logistics: Location, Timing, and Cannulation Cutoffs

ECPR Logistics: Location, Timing, and Cannulation Cutoffs

25:46Vascular Access for ECPR: Femoral-Femoral Cannulation

Vascular Access for ECPR: Femoral-Femoral Cannulation

Part 4: Post-Cannulation, Complications

28:00Post-Cannulation Management: Restoring Perfusion and Coronary Pressure

Post-Cannulation Management: Restoring Perfusion and Coronary Pressure

30:00Post-ECPR Management: Identifying Cause and Monitoring Complications

Post-ECPR Management: Identifying Cause and Monitoring Complications

31:19Understanding North-South Syndrome: Cerebral Hypoxemia

Understanding North-South Syndrome: Cerebral Hypoxemia

33:57Managing LV Ballooning and Other ECPR Complications

Managing LV Ballooning and Other ECPR Complications

Part 5: Weaning, Prognosis, Ethics

36:43Weaning ECPR: Ramp Trials and Cardiac Function Assessment

Weaning ECPR: Ramp Trials and Cardiac Function Assessment

38:20Unfavorable ECPR Trajectories: Family Communication and Consent

Unfavorable ECPR Trajectories: Family Communication and Consent

40:56Neuroprognostication and ECPR Run Duration

Neuroprognostication and ECPR Run Duration

Part 6: Expertise, Research, Future

42:13Avoiding Pitfalls: Teamwork and Patient Selection

Avoiding Pitfalls: Teamwork and Patient Selection

44:54Building ECPR Expertise: Circuit Familiarity and Questioning Dogmas

Building ECPR Expertise: Circuit Familiarity and Questioning Dogmas

46:41ECPR Research and the Power of Organ Donation

ECPR Research and the Power of Organ Donation

Part 7: Final Advice, Closing

50:31Influential Books: "Perfect Predator" and Succinylcholine Reconsideration

Influential Books: "Perfect Predator" and Succinylcholine Reconsideration

53:31The Value of Availability: Advice for Intensivists

The Value of Availability: Advice for Intensivists

55:03Closing Remarks

Closing Remarks