EDECMO Podcast

Should we keep cardiac arrest patients on the scene when we have the ability to put them on ECMO in the hospital?  That is the question we tackle this month on EDECMO.  Brian Grunau and the great crew from Prague published a study looking at the Hyperinvasive trial data.  They make some profound observations about the benefits of ECPR and some data supporting transporting patients early in functional ECPR systems. Saul Levine and Jonathan Goldstone from the SDRC join the podcast this month to give their insight into the formation of ECPR receiving centers as well as the paper.   Grunau’s Paper   The time-dependent yield of invasive vs. standard resuscitation strategies: A secondary analysis of the Prague out-of-hospital cardiac arrest study Grunau, Brian et al. Resuscitation, Volume 0, Issue 0, 110347 Editorial Shock, Shock, Go  

In this episode of the ED ECMO Podcast, hosts Zack Shinar and Jon Marinaro interview Dr. Powell & Dr. O’Connor from Baltimore Shock Trauma, exploring ECMO’s critical role in trauma care and its impact on patient outcomes. They discuss patient selection criteria for ECMO, managing hemorrhage and anticoagulation considerations, choosing between veno-arterial and veno-venous ECMO, practical insights on vascular access, and strategies for team coordination during ECMO emergencies. This discussion is essential for trauma surgeons, emergency physicians, critical care teams, perfusionists, and anyone involved in trauma care or ECMO deployment.

With the growing prevalence of ECPR, it is now more important than ever for all individuals in the medical community to understand what ECMO is, not just those providers who are directly involved with its use. In this new podcast series, Zack Shinar and Jon Marinaro help Nathaniel Dennis-Benford, a first-year medical student, explore what a medical student should know about ECMO and ECPR. In this first episode of the series, we start from the basics: what is “cardiac arrest”, how is it traditionally managed, and finally what even is ECMO?   AHA recommendations for ECPR at 2A – see article here Free link for Zack and Dinis editorial on Lactate use here

If you are running or starting a US ECMO program, this episode is a must listen.  John Mehall from Innovative ECMO Concepts goes through the financial aspects of ECMO care.  He covers everything from hospital charges to physician reimbursement to areas where hospitals commonly fail.  We all know that you cannot have a successful ECMO program unless you have sufficient funding to keep it going.  Jon Marinaro, Zack Shinar, and an entire audience of Reanimate 9 attendees join the episode to ask questions and give their own insight. Web Pricer (cms.gov) – your hospital weight.  Times it by DRG to get your hospital ECMO compensation.

This month Zack gives some pearls from his travels to Prague for Jan Behlolavek’s ECPR school, Poland to meet with Marek Dabrowski, and ELSO with the entire crew.  Zack also interviews Saul Levine for the first of what may be a recurring conversation about the San Diego Resuscitation Consortium.  His efforts along with Kristi Koenig, Shawn Evans, Todd Baumbacher, and many others have paved the way for an OHCA ECPR protocol that may change more than just San Diego cardiac care.  Listen to Saul explain how the first 3 months of this process has expanded the minds of what cardiac arrest care can look like.

  This episode is a follow up to last month’s episode with Nichole Bosson.  Zack interviews Vadim Gudzenko about the in-patient aspects and critical care doctor perspective on the Los Angeles OHCA ECPR program.  A few take homes are that EMS is critical to any OHCA ECPR program.  Nurses need support for these intense patients with high mortality.  And emergency physicians need to buy in to the idea of ECMO for cardiac arrest to make a successful program.   Upcoming Events Sept – ELSO – Summary – 34th Annual ELSO Conference (cvent.com) Oct – Prague ECPR School – https://www.ecprprague.com/ Nov – Reanimate Reanimateconference.com   Zack and Jon’s Editorial about Sakuraya PE trial https://authors.elsevier.com/a/1hlr514RWGNg8s  

One of the biggest questions in ECPR right now is how do we organize our system to provide ECPR in an effective and streamlined approach?  Nichole Bosson, Dave Shavelle and the army of L.A. ECPR enthusiasts have successfully implemented a multi-hospital ECPR receiving center program in Los Angeles.  In this episode, Zack talks with Dr. Bosson about how they started, what they learned, and where they are going.   A little about Dr. Bosson She is the Assistant Medical Director at the Los Angeles County EMS Agency. She is an Associate Clinical Professor at David Geffen School of Medicine at UCLA and faculty and EMS fellowship director in the Department of Emergency Medicine at Harbor-UCLA.   Here is the link to her paper Bosson N, Kazan C, Sanko S, Abramson T, Eckstein M, Eisner D, Geiderman J, Ghurabi W, Gudzenko V, Mehra A, Torbati S, Uner A, Gausche-Hill M, Shavelle D. Implementation of a regional extracorporeal membrane oxygenation program for refractory ventricular fibrillation out-of-hospital cardiac arrest. Resuscitation. 2023 Jun;187:109711. doi: 10.1016/j.resuscitation.2023.109711. Epub 2023 Jan 30. PMID: 36720300.   And here is Jason Bartos’ editorial Bartos JA, Yannopoulos D. Starting an Extracorporeal cardiopulmonary resuscitation Program: Success is in the details. Resuscitation. 2023 Jun;187:109792. doi: 10.1016/j.resuscitation.2023.109792. Epub 2023 Apr 10. PMID: 37044354.    

Jon Marinaro takes EDECMO through another great podcast.  This time he interviews Christine Stead, the CEO of ELSO.  She talks about how ELSO is setting up standards for ECMO programs to try to make ECMO care at all hospitals safer.  She talks about how she works also with the device industry.  This involves working with the FDA for future innovations and CMS for reimbursement issues.  She talks about the website and how to get your program certified.  Christine as a person is amazing.  She and her 5 person team runs an organization that has its hands in so many different areas.  Also, she is avid runner having completed 12 Boston Marathons!   ELSO website – www.elso.org Annual ELSO conference in Seattle Reanimate 9 is nearly sold out.  November 2023.  Check it out here

In this episode Jon Marinaro joins the ED ECMO team and interviews his colleague Sundeep Guliani, MD about the use of an ECMO first strategy for Massive Pulmonary Embolism. Jon and Sundeep review the data and processes from their institution and from other institutions in the United States.  Could it be that ECLS could move the survival needle on this high mortality disease? Listen and find out! Hobohm L, Sagoschen I, Habertheuer A, Barco S, Valerio L, Wild J, Schmidt FP, Gori T, Münzel T, Konstantinides S, Keller K. Clinical use and outcome of extracorporeal membrane oxygenation in patients with pulmonary embolism. Resuscitation. 2022 Jan;170:285-292. doi: 10.1016/j.resuscitation.2021.10.007. Epub 2021 Oct 12. PMID: 34653550. Shinar Z, Hutin A. Pulmonary ECMO-ism: Let’s add PEA to ECPR indications. Resuscitation. 2022 Jan;170:293-294. doi: 10.1016/j.resuscitation.2021.11.004. Epub 2021 Nov 10. PMID: 34774708. Pudil J, Rob D, Smalcova J, Smid O, Huptych M, Vesela M, Kovarnik T, Belohlavek J. Pulmonary embolism related refractory out-of-hospital cardiac arrest and extracorporeal cardiopulmonary resuscitation: Prague OHCA study post- hoc analysis. Eur Heart J Acute Cardiovasc Care. 2023 May 12:zuad052. doi: 10.1093/ehjacc/zuad052. Epub ahead of print. PMID: 37172033. Karami M, Mandigers L, Miranda DDR, Rietdijk WJR, Binnekade JM, Knijn DCM, Lagrand WK, den Uil CA, Henriques JPS, Vlaar APJ; DUTCH ECLS Study Group. Survival of patients with acute pulmonary embolism treated with venoarterial extracorporeal membrane oxygenation: A systematic review and meta-analysis. J Crit Care. 2021 Aug;64:245-254. doi: 10.1016/j.jcrc.2021.03.006. Epub 2021 Mar 24. PMID: 34049258.

In this episode, Jon Marinaro and Zack Shinar go through the hot off the press Inception trial.  The trial was touted as a negative ECPR study though many reasons make this trial different then the ARREST trial.  They go through several important take home points for practitioners starting or running an ECPR/ECMO program.   Inception Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2204511