EMCrit Podcast

EMCrit 343 - CV-EMCrit: Who to Refer for VV ECMO

12 snips
Feb 9, 2023
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ADVICE

Refer Before The Death Spiral

  • Call for ECMO referral before the patient reaches irreversible decline and death spiral.
  • Use EOLIA-style thresholds (PF ratio <80 for >6h or pH <7.25 with PaCO2 >60) as referral triggers, but call earlier when possible.
ADVICE

Optimize ARDS Early And Call Early

  • Aggressively optimize ARDS care early: lung-protective ventilation, proning, paralytics, volume management, and inhaled therapies.
  • If conventional measures are failing or you anticipate failure, call ECMO early rather than waiting days.
ANECDOTE

Early Aggression Prevented ECMO In Training

  • Trina recalls early program years where aggressive ventilator strategies avoided ECMO for many patients.
  • Her mentor Nader Habashi emphasized early aggressive modes like APRV to prevent progression.
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