Episode 61: ECPR with Scott Weingart

The podcast explores the use of Extracorporeal Membrane Oxygenation (ECMO) in cardiac arrest patients, known as ECPR, focusing on patient selection, cannulation techniques, and post-arrest management. Guest Scott Weingart emphasizes the importance of strict inclusion criteria for new ECPR programs, highlighting factors like patient age, rhythm (V-Fib, V-Tach preferred), and minimal comorbidities. He advocates for early CT scans to identify CPR-related injuries and the cause of the arrest. Weingart also stresses that cardiac prognostication should not be done early in post-arrest patients, as the heart can take several days to recover, and discourages early withdrawal of ECMO based on initial cardiac function assessments. The discussion also covers logistical considerations for setting up ECPR programs, including the potential for smaller hospitals to cannulate patients before transferring them to specialized centers.

Outlines

Part 1: Introduction and Patient Selection

Part 2: Logistics and Team Preparation

Part 3: Technical Execution and Cannulation

Part 4: Post-Procedure Management

Part 5: Prognosis, Ethics, and Future Outlook

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Critical Care Scenarios

Part 1: Introduction and Patient Selection

Introduction to ECPR: A Cutting-Edge Application of ECMO in Cardiac Arrest

ECPR Inclusion Criteria: Balancing Outcomes and Patient Selection

Key Factors for ECPR Eligibility: No-Flow Time, Arrest Duration, and Patient Viability

Part 2: Logistics and Team Preparation

Field Cannulation vs. Hospital Transport: System Logistics and ECPR Decision-Making

Preparing for ECPR: Team Roles, Equipment, and Sterile Procedures

ECPR Cannulation Expertise: Ultrasound Guidance and Speciality Considerations

Hybrid ECPR Approach: ED Access and CT Surgery Cannulation

ECPR Workflow: Location Agnostic and Timing Considerations for In-Hospital Arrests

Part 3: Technical Execution and Cannulation

Femoral Access Techniques: Stabilizing the Groin and Identifying Vessels During CPR

Vascular Access Strategies: Placeholder Devices, Dilators, and Decision Points

ECMO's Role in Post-Arrest Syndrome: Bridging the Critical First Few Days

Vessel Identification and Wire Placement: Ultrasound Techniques and Confirmation Methods

Dilation and Cannulation: Force, Angle, and Skill Development

Wire Selection, Cannula Placement, and Ideal Venous Cannula Position

Part 4: Post-Procedure Management

Pump Setup and Management: Simplified Technology and Trained Personnel

Heparinization Timing and the Importance of Post-CPR CT Scans

Post-Arrest CT Scans and Initial ECMO Settings: Avoiding Hyperoxia and Alkalosis

Low and Slow Approach: Optimizing ECMO Settings for Brain Protection

Part 5: Prognosis, Ethics, and Future Outlook

Cardiac vs. Neurologic Prognostication: The Importance of Delayed Cardiac Assessment

Neurologic Outcomes and Ethical Considerations: Organ Donation and Family Communication

Feasibility and Future of ECPR: Centralized Cardiac Arrest Centers and Rural ECMO Transport

Closing Remarks and Disclaimers

Episode 61: ECPR with Scott Weingart

Critical Care Scenarios

Part 1: Introduction and Patient Selection

00:08Introduction to ECPR: A Cutting-Edge Application of ECMO in Cardiac Arrest

Introduction to ECPR: A Cutting-Edge Application of ECMO in Cardiac Arrest

01:44ECPR Inclusion Criteria: Balancing Outcomes and Patient Selection

ECPR Inclusion Criteria: Balancing Outcomes and Patient Selection

04:07Key Factors for ECPR Eligibility: No-Flow Time, Arrest Duration, and Patient Viability

Key Factors for ECPR Eligibility: No-Flow Time, Arrest Duration, and Patient Viability

Part 2: Logistics and Team Preparation

07:09Field Cannulation vs. Hospital Transport: System Logistics and ECPR Decision-Making

Field Cannulation vs. Hospital Transport: System Logistics and ECPR Decision-Making

10:01Preparing for ECPR: Team Roles, Equipment, and Sterile Procedures

Preparing for ECPR: Team Roles, Equipment, and Sterile Procedures

12:30ECPR Cannulation Expertise: Ultrasound Guidance and Speciality Considerations

ECPR Cannulation Expertise: Ultrasound Guidance and Speciality Considerations

15:31Hybrid ECPR Approach: ED Access and CT Surgery Cannulation

Hybrid ECPR Approach: ED Access and CT Surgery Cannulation

18:52ECPR Workflow: Location Agnostic and Timing Considerations for In-Hospital Arrests

ECPR Workflow: Location Agnostic and Timing Considerations for In-Hospital Arrests

Part 3: Technical Execution and Cannulation

20:21Femoral Access Techniques: Stabilizing the Groin and Identifying Vessels During CPR

Femoral Access Techniques: Stabilizing the Groin and Identifying Vessels During CPR

23:40Vascular Access Strategies: Placeholder Devices, Dilators, and Decision Points

Vascular Access Strategies: Placeholder Devices, Dilators, and Decision Points

27:01ECMO's Role in Post-Arrest Syndrome: Bridging the Critical First Few Days

ECMO's Role in Post-Arrest Syndrome: Bridging the Critical First Few Days

29:56Vessel Identification and Wire Placement: Ultrasound Techniques and Confirmation Methods

Vessel Identification and Wire Placement: Ultrasound Techniques and Confirmation Methods

33:08Dilation and Cannulation: Force, Angle, and Skill Development

Dilation and Cannulation: Force, Angle, and Skill Development

36:05Wire Selection, Cannula Placement, and Ideal Venous Cannula Position

Wire Selection, Cannula Placement, and Ideal Venous Cannula Position

Part 4: Post-Procedure Management

39:00Pump Setup and Management: Simplified Technology and Trained Personnel

Pump Setup and Management: Simplified Technology and Trained Personnel

42:36Heparinization Timing and the Importance of Post-CPR CT Scans

Heparinization Timing and the Importance of Post-CPR CT Scans

45:09Post-Arrest CT Scans and Initial ECMO Settings: Avoiding Hyperoxia and Alkalosis

Post-Arrest CT Scans and Initial ECMO Settings: Avoiding Hyperoxia and Alkalosis

47:37Low and Slow Approach: Optimizing ECMO Settings for Brain Protection

Low and Slow Approach: Optimizing ECMO Settings for Brain Protection

Part 5: Prognosis, Ethics, and Future Outlook

50:03Cardiac vs. Neurologic Prognostication: The Importance of Delayed Cardiac Assessment

Cardiac vs. Neurologic Prognostication: The Importance of Delayed Cardiac Assessment

53:31Neurologic Outcomes and Ethical Considerations: Organ Donation and Family Communication

Neurologic Outcomes and Ethical Considerations: Organ Donation and Family Communication

56:28Feasibility and Future of ECPR: Centralized Cardiac Arrest Centers and Rural ECMO Transport

Feasibility and Future of ECPR: Centralized Cardiac Arrest Centers and Rural ECMO Transport

1:00:21Closing Remarks and Disclaimers

Closing Remarks and Disclaimers