ECMO Essentials with Dr. Karen Fauman & the Cribsiders--Part 2
Mar 8, 2023
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Dr. Karen Fauman, an associate professor of Pediatrics at the University of Chicago and dual boarded pediatric intensivist and palliative care physician, discusses the pathophysiology of oxygen delivery, indications for VV and VA ECMO, interpreting flow and RPM measurements, assessing lung recovery through air bronchograms, and the process of weaning a patient from ECMO with the Cribsiders.
Understanding the indications for ECMO and the potential risks and benefits is crucial before initiating treatment.
Monitoring parameters such as flow, sweep, and gas exchange are vital in caring for patients on ECMO.
Deep dives
Overview of ECMO and its Applications
ECMO is a resource and personnel-intensive therapy that focuses on oxygen delivery. It is important to carefully consider the indications for ECMO and the potential risks and benefits before initiating treatment. Understanding the need for oxygen delivery is key to comprehending the principles of ECMO.
Monitoring and Managing Patients on ECMO
Monitoring parameters such as flow, sweep, and gas exchange are crucial in caring for patients on ECMO. In VA ECMO, increasing pulsatility and stable hemodynamics indicate potential recovery. In VV ECMO, achieving appropriate tidal volumes, optimizing sweep and gas settings, and weaning oxygen flow can signal readiness for liberation from ECMO support.
Considerations for ECMO Outcomes
ECMO outcomes vary depending on various factors. Neonates with conditions like persistent pulmonary hypertension of the newborn tend to have favorable outcomes. Oncology patients, especially those with active disease or delayed immune recovery, may have higher risks and poorer outcomes. Being aware of patient characteristics and prognosis is essential in decision-making and counseling.
Critical Thinking and Palliative Care
ECMO requires thoughtful decision-making and consideration of potential complications and outcomes. It is important to approach ECMO as a therapy that demands stewardship and proactive discussions about goals of care, potential complications, and possible next steps. Integrating palliative care principles into ECMO management promotes holistic patient care.
Karen Fauman, MD is an Associate Professor of Pediatrics at the University of Chicago and dual boarded pediatric intensivist and palliative care physician at Comer Children’s. She received her medical degree, pediatric and pediatric critical care training at the University of Michigan. Now at the University of Chicago she serves as the critical care medicine fellowship program director and the ECMO medical director. She is very active in ECMO-related research with an added focus on the psychosocial aspects of critical care in children.
The Cribsiders is a pediatric medicine podcast composed of a national network of students, residents and clinician educators from across the country and multiple institutions. On the show we “curbside” the experts to deconstruct various topics in the world of medicine to provide listeners with clinical pearls, practice-changing knowledge and a weight-based dosing of fun.
Learning Objectives:
After listening to this episode listeners will…
Recall the basic pathophysiology of oxygen delivery
Identify the different indications for VV and VA ECMO
Be familiar with the basic sequence of the ECMO circuit
Recognize ECMO settings and how changing these will impact oxygenation and ventilation
Be familiar with signs that a patient may be ready to be liberated from ECMO
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Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.comfor detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.
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