Dr. Eddy Fan, ECMO specialist, discusses patient-centric approaches to ECMO. They cover patient selection, equity in access to ECMO treatment, transport teams for ECMO patients, and strategies for special populations during the pandemic.
Focus on patient-centered care in ECMO management for optimal outcomes.
Consider specific criteria and evidence-based guidelines for initiating ECMO support in severe ARDS cases.
Deep dives
Understanding the Patient-Centered Approach to ECMO
ECMO should be approached with a patient-centered focus, considering the patient as the central component rather than solely focusing on the life support devices. It is essential to prioritize the patient's condition over the machinery, ensuring that any issues or concerns are first evaluated by looking at the patient directly. By starting with the patient's well-being as the primary focus, healthcare professionals can navigate through challenges more effectively, maintaining a clear perspective on providing optimal care.
Evidence-Based Guidelines and Recommendations for ECMO Use
Recent evidence, including trials like Caeser and EOLIA, supports the use of ECMO in patients with severe ARDS. The European and updated ATS guidelines now recommend ECMO for these specific cases, particularly for adult patients with acutely reversible respiratory failure and severe hypoxemia. Following specific inclusion criteria, such as low PF ratios and respiratory acidosis despite optimized ventilation, can guide clinicians on when ECMO is indicated.
Determining the Timely Initiation of ECMO Support
Initiating ECMO support should be considered promptly for patients meeting specific criteria, including severe hypoxemia persisting despite optimized therapies. Early referral to ECMO centers and establishing relationships for timely transfers are crucial to ensure patients receive necessary support. Monitoring the patient's progression, considering the trajectory of deterioration, and engaging proactive discussions enhance the likelihood of successful ECMO interventions.
Critical Considerations for ECMO Termination and Patient Outcomes
Decision-making regarding ECMO termination requires a comprehensive evaluation of the patient's progress and response to treatment. Engaging in open communication with surrogate decision-makers and families is vital to provide transparent updates on the patient's status. While some patients may require extended ECMO support, understanding the potential for lung recovery and multi-organ failure guides decisions on continuation. Balancing the duration of ventilation, patient outcomes, and physiological age influences the decision-making process.
We return to our Canadian Critical Care Forum series with this episode.
In this episode, we delve into the world of Extracorporeal Membrane Oxygenation (ECMO) with Dr. Eddy Fan, a leading expert in critical care and ECMO specialist.
Eddy Fan is an associate professor in the Interdepartmental Division of Critical Care Medicine and the Institute of Health Policy, Management, and Evaluation at the University of Toronto and a staff intensivist at the University Health Network/Mount Sinai Hospital. Dr. Fan received his undergraduate degree from the University of Toronto, his medical degree from the University of Western Ontario, and a PhD in Clinical Investigation from Johns Hopkins University. He is currently the Medical Director of the Extracorporeal Life Support Program at the Toronto General Hospital, and the Director of Critical Care Research at the University Health Network/Mount Sinai Hospital. Dr. Fan’s research has focused on advanced life support for acute respiratory failure and patient outcomes from critical illness. These include investigations on the epidemiology and use of mechanical ventilation and extracorporeal life support in patients with ARDS, as well as on the development of ICU-acquired weakness, early rehabilitation in ICU patients, and long-term outcomes in survivors of critical illness.
Join us as we take on this huge topic.
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