42. Extracorporeal Membrane Oxygenation

This podcast episode provides an introduction to Extracorporeal Membrane Oxygenation (ECMO), differentiating between Veno-Venous (VV) and Veno-Arterial (VA) ECMO. The discussion covers practical considerations such as patient selection, cannulation strategies, and the importance of multidisciplinary teams in ECMO management. For VV ECMO, the conversation highlights the need to maximize conventional therapies and the evolving understanding of ventilator-induced lung injury. VA ECMO discussion emphasizes its role in cardiopulmonary support, particularly in cases of obstructive shock and ECPR (Extracorporeal Cardiopulmonary Resuscitation), while also addressing the complexities of differential hypoxemia and the integration of other mechanical circulatory support devices. The experts stress the importance of continuous evaluation to avoid therapeutic inertia.

Outlines

Part 1: Introduction, Basics

Part 2: Configurations, Research

Part 3: VV-ECMO, Clinical Management

Part 4: Technical Execution, Mobility

Part 5: VA-ECMO, eCPR

Part 6: Physiology, Complications

Part 7: Conclusion

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Critical Care Time

Part 1: Introduction, Basics

Introduction to ECMO: Overcoming Recording Challenges and Setting the Stage

ECMO Experts' Origin Stories and Defining ECMO's Purpose

The Growing Importance and Accessibility of ECMO in Modern Medicine

Part 2: Configurations, Research

ECMO Configurations: VV and VA, Cannulation, and Flow Dynamics

ECMO Research, Configurations, and Institutional Approaches

Part 3: VV-ECMO, Clinical Management

VV-ECMO Case Study: COVID-19 ARDS and Maximizing Conventional Therapy

Evolving Perspectives on Lung Injury and the Art of ECMO Decision-Making

Criteria for ECMO Initiation and the Importance of Lung Rest

Tools and Calculators for ECMO Candidacy and the Value of Calling ECMO Centers

Part 4: Technical Execution, Mobility

Practicalities of ECMO: Cannula Selection, Placement, and Terminology

Ventilator Titration, Lung Rest, and the Importance of Mobility on VV-ECMO

Cannulation Configuration, Flow Goals, and Decoupling PCO2 Clearance

Ultra-Protective Ventilation, Liberation, and the RV Death Spiral

Part 5: VA-ECMO, eCPR

Addressing RV Failure and Transitioning to VA ECMO

VA ECMO and eCPR: A Case of Massive PE and the Importance of Time

eCPR Logistics: Minimizing Low Flow Time and Confirming Cannula Placement

Confirming Cannula Placement and Physiological Differences in VA ECMO

Part 6: Physiology, Complications

VA ECMO Cannulation and the Interaction of Thrombolytics

Retrograde Flow and Differential Hypoxemia in VA ECMO

Managing Differential Hypoxemia and VA ECMO in Cardiogenic Shock

Evolving Approaches to Cardiogenic Shock and the Importance of De-Escalation

Part 7: Conclusion

Closing Remarks and Gratitude

42. Extracorporeal Membrane Oxygenation

Critical Care Time

Part 1: Introduction, Basics

00:02Introduction to ECMO: Overcoming Recording Challenges and Setting the Stage

Introduction to ECMO: Overcoming Recording Challenges and Setting the Stage

04:05ECMO Experts' Origin Stories and Defining ECMO's Purpose

ECMO Experts' Origin Stories and Defining ECMO's Purpose

07:38The Growing Importance and Accessibility of ECMO in Modern Medicine

The Growing Importance and Accessibility of ECMO in Modern Medicine

Part 2: Configurations, Research

12:10ECMO Configurations: VV and VA, Cannulation, and Flow Dynamics

ECMO Configurations: VV and VA, Cannulation, and Flow Dynamics

17:24ECMO Research, Configurations, and Institutional Approaches

ECMO Research, Configurations, and Institutional Approaches

Part 3: VV-ECMO, Clinical Management

20:36VV-ECMO Case Study: COVID-19 ARDS and Maximizing Conventional Therapy

VV-ECMO Case Study: COVID-19 ARDS and Maximizing Conventional Therapy

27:03Evolving Perspectives on Lung Injury and the Art of ECMO Decision-Making

Evolving Perspectives on Lung Injury and the Art of ECMO Decision-Making

34:36Criteria for ECMO Initiation and the Importance of Lung Rest

Criteria for ECMO Initiation and the Importance of Lung Rest

39:29Tools and Calculators for ECMO Candidacy and the Value of Calling ECMO Centers

Tools and Calculators for ECMO Candidacy and the Value of Calling ECMO Centers

Part 4: Technical Execution, Mobility

45:27Practicalities of ECMO: Cannula Selection, Placement, and Terminology

Practicalities of ECMO: Cannula Selection, Placement, and Terminology

52:37Ventilator Titration, Lung Rest, and the Importance of Mobility on VV-ECMO

Ventilator Titration, Lung Rest, and the Importance of Mobility on VV-ECMO

58:52Cannulation Configuration, Flow Goals, and Decoupling PCO2 Clearance

Cannulation Configuration, Flow Goals, and Decoupling PCO2 Clearance

1:04:00Ultra-Protective Ventilation, Liberation, and the RV Death Spiral

Ultra-Protective Ventilation, Liberation, and the RV Death Spiral

Part 5: VA-ECMO, eCPR

1:10:41Addressing RV Failure and Transitioning to VA ECMO

Addressing RV Failure and Transitioning to VA ECMO

1:15:13VA ECMO and eCPR: A Case of Massive PE and the Importance of Time

VA ECMO and eCPR: A Case of Massive PE and the Importance of Time

1:20:20eCPR Logistics: Minimizing Low Flow Time and Confirming Cannula Placement

eCPR Logistics: Minimizing Low Flow Time and Confirming Cannula Placement

1:24:47Confirming Cannula Placement and Physiological Differences in VA ECMO

Confirming Cannula Placement and Physiological Differences in VA ECMO

Part 6: Physiology, Complications

1:28:28VA ECMO Cannulation and the Interaction of Thrombolytics

VA ECMO Cannulation and the Interaction of Thrombolytics

1:34:34Retrograde Flow and Differential Hypoxemia in VA ECMO

Retrograde Flow and Differential Hypoxemia in VA ECMO

1:42:48Managing Differential Hypoxemia and VA ECMO in Cardiogenic Shock

Managing Differential Hypoxemia and VA ECMO in Cardiogenic Shock

1:47:06Evolving Approaches to Cardiogenic Shock and the Importance of De-Escalation

Evolving Approaches to Cardiogenic Shock and the Importance of De-Escalation

Part 7: Conclusion

1:53:13Closing Remarks and Gratitude

Closing Remarks and Gratitude