EDECMO Podcast 56: Pressors, Fluid, or Flow – Optimizing ECMO Physiology
8 snips
Jul 8, 2019 
Marc Dickstein, an anesthesiologist from Columbia University, shares his expertise on managing patients on ECMO. He highlights the critical decisions between fluids, pressors, and flow to optimize outcomes. The discussion covers the complexities of left ventricular recovery post-arrest, and how hemodynamics impact oxygen delivery. Dickstein explains the importance of pulmonary artery catheters and the challenges of heart distension after cardiac arrest. His insights emphasize the necessity of understanding ECMO physiology for effective patient care.
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Ejecting Heart Crucial on ECMO
- A non-ejecting heart on ECMO is dangerous due to distension and pulmonary edema risk.
- The heart must eject to avoid thrombosis and ensure oxygenated blood reaches coronaries and brain.
Lower MAP To Improve Ejection
- Lower the mean arterial pressure (MAP) to ease heart ejection, ideally to 60-70 mmHg.
- Use echo and catheter data to evaluate if the heart is underfilled and consider volume if necessary.
Maximize Flow Over Vasopressors
- Maximize ECMO flow to raise pressure and improve oxygen delivery.
- Avoid relying heavily on vasopressors as they increase vascular resistance and reduce flow.
