VA ECMO with Dr. Priya Bhaskar

Oct 23, 2023

Dr. Priya Bhaskar, an associate professor of pediatrics and attending in the cardiac ICU at UT Southwestern, discusses VA ECMO in pediatrics. Topics include indications for VA ECMO, cannulation strategies, hemodynamic complications, weaning strategies, and the advantages of ventricular assist devices over ECMO.

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Introduction

00:00 • 4min

The Importance of a Cardiac ICU Fellowship and Indications for VA ECMO in the PICU

04:23 • 13min

Different Approaches for Cannulation and Vessel Repair in VA ECMO

17:31 • 3min

Preserving the Brain and Ensuring Oxygen Delivery in VA ECMO

20:40 • 13min

Weaning ECMO Flows and Monitoring Tolerance

33:57 • 5min

Advantages of VAD over ECMO and Resources for VAD and ECMO

39:23 • 4min

Priya Bhaskar, M.D. is an Associate Professor of Pediatrics at UT Southwestern and an attending in the Cardiac ICU at Children’s Medical Center Dallas. She completed her pediatric residency at Inova Children’s Hospital in Virginia and critical care fellowship at UTSW prior to completing a 1 year CICU fellowship at Laurie Children’s in Chicago. Prior to her current position here at UTSW she was a cardiac intensivist at Arkansas Children’s Hospital. Her professional interests include extracorporeal support and education. She serves on the ECMO team as a core staff physician, and she has co-authored a review on this topic that we will use to guide our conversation.

Learning Objectives:

By the end of this podcast, listeners should be able to discuss:

The general indications for VA-ECMO in pediatrics.
The anatomic and physiologic rationale supporting various VA-ECMO cannulation strategies.
Physiologic targets to ensure adequate oxygen delivery for patients on VA-ECMO.
Hemodynamic complications of VA-ECMO such as left atrial hypertension and harlequin syndrome and general strategies in their management.
Liberation strategies for VA-ECMO either to decannulation or conversion to ventricular assist device.

References:

Bhaskar, P., Davila, S., Hoskote, A., & Thiagarajan, R. (2021). Use of ECMO for Cardiogenic Shock in Pediatric Population. Journal of clinical medicine, 10(8), 1573. https://doi.org/10.3390/jcm10081573

Brown G, Moynihan KM, Deatrick KB, Hoskote A, Sandhu HS, Aganga D, Deshpande SR, Menon AP, Rozen T, Raman L, Alexander PMA. Extracorporeal Life Support Organization (ELSO): Guidelines for Pediatric Cardiac Failure. ASAIO J. 2021 May 1;67(5):463-475. doi: 10.1097/MAT.0000000000001431. Erratum in: ASAIO J. 2022 Jul 1;68(7):e129. PMID: 33788796.

Xie A, Forrest P, Loforte A. Left ventricular decompression in veno-arterial extracorporeal membrane oxygenation. Ann Cardiothorac Surg. 2019 Jan;8(1):9-18. doi: 10.21037/acs.2018.11.07. PMID: 30854308; PMCID: PMC6379183.

https://www.elso.org/ecmo-resources/elso-ecmo-guidelines.aspx

https://www.congenitalheartacademy.com/home

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