Extracorporeal Cardiopulmonary Resuscitation (ECPR) with Dr. Lakshmi Raman
Oct 31, 2022
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Dr. Lakshmi Raman, pediatric cardiopulmonary resuscitation (ECPR) expert, discusses the rationale for ECPR in pediatric cardiac arrest, patient selection for ECPR, and challenges in determining the cause of arrest. They also delve into choosing the best cannulation location for ECPR and the preferred access for children over 30 kilos. The importance of being an experienced program in handling high-stress situations like ECMO and deploying ECPR is emphasized.
Early identification of ECPR candidates is crucial to ensure preparedness and avoid last-minute difficulties.
ECPR serves as a bridge to recovery, decision-making, or transplant, providing vital support to patients with reversible causes of cardiac arrest.
Deep dives
Importance of Experience and Preparation for ECPR
ECPR requires a high level of resources and coordination, making it essential for teams with experience in the procedure. Identifying ECPR candidates early on is crucial to ensure preparedness and avoid last-minute difficulties.
Dr. Lakshmi Raman's Background and Interest in ECMO
Dr. Lakshmi Raman is an experienced pediatric intensivist with a passion for ECMO. Her interest in ECMO started during her critical care fellowship when she encountered a patient on ECMO for cardiac support. Since then, she has focused on understanding neurological injuries and neuro monitoring in ECMO patients.
ECPR as a Bridge to Decision and Bridge to Transplant
ECPR not only serves as a bridge to recovery, but it can also be a bridge to decision-making or a bridge to transplant in certain cases. It provides vital support to patients with reversible causes of cardiac arrest, allowing time for further evaluation and determining the appropriate course of action.
Determining ECPR Candidates and Enhancing Outcomes
ECPR candidates are carefully evaluated based on their underlying disease process, comorbidities, and the reason for cardiac arrest. Cardiac patients have higher chances of benefiting from ECPR due to potential reversibility, the presence of some oxygenated blood during CPR, and the ability to establish flows through ECMO.
Dr. Lakshmi Raman is a Professor of Pediatrics at UT Southwestern and a pediatric intensivist at Children’s Medical Center Dallas. She serves as the Medical Director of the Extracorporeal Membrane Oxygenation (ECMO) program at CMC. She is active in ELSO and serves as the Chair of Publications. She also co-authored the 2021 ELSO Pediatric ECPR guidelines.
Objectives:
By the end of listening to this episode, learners should be able to:
Define ECPR.
Understand the rationale for ECPR in cardiopulmonary arrest in children.
Recognize aspects of high-quality ECPR.
Understand the patient selection, context and setting that is most appropriate for pediatric ECPR.
Recognize when it is appropriate to activate the ECPR team after pediatric cardiac arrest.
Understand the rationale of choosing the location of cannulation (i.e., peripheral vs. central).
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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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