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Emergency ECMO

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1. A paediatric case of severe tracheobronchial injury successfully treated surgically after early CT diagnosis and ECMO safely performed in the hybrid emergency room. (PubMed)

A paediatric case of severe tracheobronchial injury successfully treated surgically after early CT diagnosis and ECMO safely performed in the hybrid emergency room. In paediatric trauma patients, tracheobronchial injury can be a rare, life-threatening trauma. In 2011, we instituted a new trauma workflow concept called the hybrid emergency room (Hybrid ER) that combines a sliding CT scanning system with interventional radiology features to permit CT examination and emergency therapeutic (...) intervention without moving the patient. Extracorporeal membrane oxygenation (ECMO) can lead to cannula-related complications. However, procedures supported by moveable C-arm fluoroscopy and ultrasonography equipment can be performed soon after early CT examination. We report a paediatric patient with tracheobronchial injury diagnosed by CT examination who underwent rapid resuscitation and safe installation of veno-venous (VV) ECMO in our Hybrid ER and was successfully treated by surgery.A 11-year-old boy

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2019 Scandinavian journal of trauma, resuscitation and emergency medicine

2. Practice Characteristics of Emergency Department Extracorporeal Cardiopulmonary Resuscitation (eCPR) Programs in the United States: The Current State of the Art of Emergency Department Extracorporeal Membrane Oxygenation (ED ECMO). (PubMed)

Practice Characteristics of Emergency Department Extracorporeal Cardiopulmonary Resuscitation (eCPR) Programs in the United States: The Current State of the Art of Emergency Department Extracorporeal Membrane Oxygenation (ED ECMO). To characterize the current scope and practices of centers performing extracorporeal cardiopulmonary resuscitation (eCPR) on the undifferentiated patient with cardiac arrest in the emergency department.We contacted all US centers in January 2016 that had submitted (...) adult eCPR cases to the Extracorporeal Life Support Organization (ELSO) registry and surveyed them, querying for programs that had performed eCPR in the Emergency Department (ED ECMO). Our objective was to characterize the following domains of ED ECMO practice: program characteristics, patient selection, devices and techniques, and personnel.Among 99 centers queried, 70 responded. Among these, 36 centers performed ED ECMO. Nearly 93% of programs are based at academic/teaching hospitals. 65

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2016 Resuscitation

3. Emergency ECMO

Emergency ECMO Emergency ECMO Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Emergency ECMO Emergency ECMO Aka: Emergency ECMO , ECMO (...) , Extracorporeal Membrane Oxygenation , Extracorporeal Cardiopulmonary Resuscitation , ECPR , Extracorporeal Life Support , ECLS II. Prerequisites Emergency ECMO is limited to tertiary institutions that have the equipment to perform cardiopulmonary bypass Emergency ECMO is time, training and resource intensive III. Indications Cardiopulmonary Bypass Original indication dating back to its 1950 introduction Severe Core <32 C or 89.6 F) AND Cardiac instability (including , ) Extracorporeal Life Support (ECLS

2018 FP Notebook

4. Refractory V FIb Arrest, put on ECMO, regains an organized rhythm, and a 12-lead is recorded.

Refractory V FIb Arrest, put on ECMO, regains an organized rhythm, and a 12-lead is recorded. Dr. Smith's ECG Blog: Refractory V FIb Arrest, put on ECMO, regains an organized rhythm, and a 12-lead is recorded. Monday, May 22, 2017 I received this case from: Dominic Larose MD CCFP(EM) FACEP Alain Vadeboncoeur MD CSPQ Montreal Heart Institute Hi Steve, Here is a case I had a while ago. The patient was seen on the street, with sudden LOC. An off duty fireman was a bystander, so the cardiac arrest (...) , contemporary trops are stated in ng/mL and high sensitivity (hs) in ng/L. Troponin T values are far lower than cTnI, so this is (very) roughly equivalent to a hs cTnI of 10,000 ng/L (contemporary cTnI of 10.0 ng/mL. Strict troponin officionados would faint at such an attempt at equivalence, but there is literature to support this and I find it very useful, especially in EKG research.] I decided to activate the ECMO team at 45 minutes post arrest, three minutes after arrival in the ED, for this middle aged

2017 Dr Smith's ECG Blog

5. Emergency ECMO

Emergency ECMO Emergency ECMO Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Emergency ECMO Emergency ECMO Aka: Emergency ECMO , ECMO (...) , Extracorporeal Membrane Oxygenation , Extracorporeal Cardiopulmonary Resuscitation , ECPR , Extracorporeal Life Support , ECLS II. Prerequisites Emergency ECMO is limited to tertiary institutions that have the equipment to perform cardiopulmonary bypass Emergency ECMO is time, training and resource intensive III. Indications Cardiopulmonary Bypass Original indication dating back to its 1950 introduction Severe Core <32 C or 89.6 F) AND Cardiac instability (including , ) Extracorporeal Life Support (ECLS

2017 FP Notebook

6. The pre-ECMO simplified acute physiology score II as a predictor for mortality in patients with initiation ECMO support at the emergency department for acute circulatory and/or respiratory failure: a retrospective study. (PubMed)

The pre-ECMO simplified acute physiology score II as a predictor for mortality in patients with initiation ECMO support at the emergency department for acute circulatory and/or respiratory failure: a retrospective study. In the emergency department (ED), extracorporeal membrane oxygenation (ECMO) can be used as a rescue treatment modality for patients with refractory circulatory and/or respiratory failure. Serious consideration must be given to the indication, and the PRESERVE and RESP scores (...) for mortality have been investigated. However these scores were validated to predict survival in patients who received mainly veno-venous (VV) ECMO in the intensive care unit. The aim of the present study was to investigate the factors that predicted the outcomes for patients who received mixed mode (veno-arterial [VA] and VV) ECMO support in the ED.This single center retrospective study included 65 patients who received ECMO support at the ED for circulatory or respiratory failure between January 2009

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2015 Scandinavian journal of trauma, resuscitation and emergency medicine

7. Transesophageal echocardiography identification of aortic dissection during cardiac arrest and cessation of ECMO initiation. (PubMed)

Transesophageal echocardiography identification of aortic dissection during cardiac arrest and cessation of ECMO initiation. Cardiac arrest is a challenging clinical presentation that emergency medicine providers often encounter. Aortic dissection is an uncommon etiology in all-comers presenting in cardiac arrest. The use of bedside point of care echocardiography to aid in resuscitative efforts is expanding, particularly with the increasing use of transesophageal echocardiography (TEE (...) ) by emergency medicine providers. Additionally, emergency department initiation of extracorporeal membrane oxygenation (ECMO) is a relatively newer development in emergency department practice. We report the case of a 64-year old male presenting to the emergency department in cardiac arrest with TEE identification of aortic dissection as the etiology resulting in discontinuation of ECMO initiation attempts.Copyright © 2019. Published by Elsevier Inc.

2019 American Journal of Emergency Medicine

8. Everything ECMO!

Everything ECMO! Everything ECMO • LITFL Medical Blog • Critical Care Emergency medicine and critical care medical education blog Search LITFL ... | | | Everything ECMO , last update September 4, 2018 In specialist centres, extracorporeal membrane oxygenation (ECMO) is a now a mainstay of the management of cardio/respiratory failure refractory to other measures. However, much of the clinical information required to care for ECMO patients at the bedside remains inaccessible to learners (...) an intensivist and ECMO specialist at the Alfred ICU, and editor and co-creator of INTENSIVE and the “Everything ECMO” series. About Dr Chris Nickson An emergency physician and intensivist suffering from a bad case of knowledge . Key areas of interest include: the ED-ICU interface, toxicology, simulation and the free open-access meducation (FOAM) revolution. @ | | | Reader Interactions Leave a Reply This site uses Akismet to reduce spam. . Recent Posts Footer LITFL posts by or LITFL Review by or FFFF

2018 Life in the Fast Lane Blog

9. The ECMO Project: Lend us a Hand!!!

The ECMO Project: Lend us a Hand!!! The ECMO Project: Lend us a Hand!!! | thinking critical care Menu So I’ve been quite passionate about adding ECPR to our shop for quite a while now, but bureaucratic hospital processes, particularly in Quebec these days, has us bogged down and makes progress slow and painful, despite good intentions. So we need a boost, not only to be able to offer this technology to our patients, but more importantly, to show that it can be done in a community hospital (...) , that all you need is the desire to give your cardiac arrest patients the best chance at neurologically intact survival they can get. Here’s a little explanation, particularly for the non-medical readers: That, and of course a pre-determined corridor to a tertiary care center with a cath lab and a compatible ECMO system to yours. We have the good fortune to be a couple blocks from the Montreal Heart Institute who are interested in collaborating, and we have the desire, skill and motivation to pull

2019 Thinking critical care blog

10. "Shark fin" ECG in I, aVL, V4 and V5. Which artery? Hint: patient is in shock and was put on ECMO

"Shark fin" ECG in I, aVL, V4 and V5. Which artery? Hint: patient is in shock and was put on ECMO Dr. Smith's ECG Blog: "Shark fin" ECG in I, aVL, V4 and V5. Which artery? Hint: patient is in shock and was put on ECMO Saturday, March 26, 2016 This was contributed by Rohin Francis (Twitter: @MedCrisis), a cardiologist from England and FOAM enthusiast. Case A 55 year old lady initially presented to hospital with an acutely ischaemic arm. An embolic occlusion of her brachial artery was diagnosed (...) and the cardiac arrest and ECMO teams were alerted. This was the initial shot of her angiogram: The guide catheter was deliberately not engaged with the left main artery, as an occlusion was suspected. Here one can see contrast being injected towards the left main and a large thrombus sitting at the ostium. A small amount of flow is passing but not reaching further than proximal circumflex nor LAD. There is sluggish clearance of contrast from the aortic root indicative of poor cardiac output. An intra-aortic

2016 Dr Smith's ECG Blog

11. ECMO use and mortality in adult patients with cardiogenic shock: a retrospective observational study in U.S. hospitals. (PubMed)

Nationwide Emergency Department Sample (NEDS) database of 2013 was conducted. Weighted visits for cardiogenic shock (discharge diagnosis) with ECMO use were included. Collected data was analyzed and variables associated with mortality were identified.A total of 922 weighted patients with cardiogenic shock and ECMO were included. Mean age was 50.8 years. They were more commonly males (66.3%; n = 658). Slightly over half (51.0%, n = 506) survived to hospital discharge. Mean charges per patient were (...) ECMO use and mortality in adult patients with cardiogenic shock: a retrospective observational study in U.S. hospitals. Extracorporeal membrane oxygenation (ECMO) is increasingly used in resuscitation of critically ill patients with documented improved survival. Few studies describe ECMO use in cardiogenic shock. This study examines ECMO use and identifies variables associated with mortality in patients treated for cardiogenic shock in US hospitals.A retrospective observational study of the US

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2018 BMC Emergency Medicine

12. Position paper for the organization of ECMO programs for cardiac failure in adults. (PubMed)

Position paper for the organization of ECMO programs for cardiac failure in adults. Extracorporeal membrane oxygenation (ECMO) has been used increasingly for both respiratory and cardiac failure in adult patients. Indications for ECMO use in cardiac failure include severe refractory cardiogenic shock, refractory ventricular arrhythmia, active cardiopulmonary resuscitation for cardiac arrest, and acute or decompensated right heart failure. Evidence is emerging to guide the use of this therapy (...) for some of these indications, but there remains a need for additional evidence to guide best practices. As a result, the use of ECMO may vary widely across centers. The purpose of this document is to highlight key aspects of care delivery, with the goal of codifying the current use of this rapidly growing technology. A major challenge in this field is the need to emergently deploy ECMO for cardiac failure, often with limited time to assess the appropriateness of patients for the intervention

2018 Intensive Care Medicine

13. Use of ECMO in ARDS: does the EOLIA trial really help? (PubMed)

Use of ECMO in ARDS: does the EOLIA trial really help? 29976250 2018 11 14 1466-609X 22 1 2018 Jul 05 Critical care (London, England) Crit Care Use of ECMO in ARDS: does the EOLIA trial really help? 171 10.1186/s13054-018-2098-6 Gattinoni Luciano L Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Robert-Koch-Straße, 40, 37075, Göttingen, Germany. gattinoniluciano@gmail.com. Vasques Francesco F Department of Anesthesiology, Emergency and Intensive (...) Care Medicine, University of Göttingen, Robert-Koch-Straße, 40, 37075, Göttingen, Germany. Quintel Michael M Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Robert-Koch-Straße, 40, 37075, Göttingen, Germany. eng Editorial 2018 07 05 England Crit Care 9801902 1364-8535 2018 05 31 2018 06 19 2018 7 7 6 0 2018 7 7 6 0 2018 7 7 6 0 epublish 29976250 10.1186/s13054-018-2098-6 10.1186/s13054-018-2098-6 PMC6034241 Am J Respir Crit Care Med. 1994 Feb;149(2 Pt 1

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2018 Critical Care

14. Von Willebrand Factor Concentrate During ECMO Support

support (MCS) by extracorporeal membrane oxygenation (ECMO) and ventricular assist devices (VAD) can provoke premature degradation of high molecular weight (HMW) of von Willebrand factor (vWF) multimers. In patients with intractable cardiac and/or respiratory failure requiring emergency ECMO support, the investigators recently demonstrated an essential decrease in high molecular weight (HMW) vWF multimer bands 24 and 48 hours after initiation of ECMO compared to baseline. Blood loss and transfusion (...) the primary aim of this clinical trial is to find out if the need of PRBCs differs in the group receiving a von Willebrand factor concentrate (vWFC), or the placebo group (saline). This clinical trial is planned as a randomized, double-blind, prospective, controlled, two-arm, two-center study. Patients with intractable cardiac and/or respiratory failure requiring emergency ECMO support undergoing surgery (Department of Anaesthesiology and Intensive Care Medicine) or treated at the General and Surgical

2018 Clinical Trials

15. Rapid Response VA-ECMO in Refractory Out-of-hospital Cardiac Arrest

Rapid Response VA-ECMO in Refractory Out-of-hospital Cardiac Arrest Rapid Response VA-ECMO in Refractory Out-of-hospital Cardiac Arrest - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Rapid Response VA-ECMO (...) be reversible and damage to other organs is limited at the time of the arrest. Many patients will have a coronary event that can be treated by angioplasty. However, up to now absence of ROSC poses a barrier for angioplasty, and most patients are therefore not even transported to a hospital. With the use of extra corporeal membrane oxygenation (ECMO) the circulation can be restored immediately, providing time to diagnose and treat the underlying cause of the cardiac arrest. International cohort studies show

2018 Clinical Trials

16. Pre-hospital ECMO in Advanced Resuscitation in Patients With Refractory Cardiac Arrest. ( SUB30 )

31 and 45 minutes; and 46 and 60 minutes. ] The number of patients successfully cannulated 31 and 45 minutes Number of patients with return of spontaneous circulations (ROSC) [ Time Frame: Within 20 minutes of cardiac arrest ] The number of patients patients who achieve ROSC prior to the 20 minutes timeout, number of patients in refractory cardiac arrest at 20 minutes in whom ROSC is achieved prior to ECMO flow Emergency call-out time frame [ Time Frame: At 30 minutes after cardiac arrest (...) ] The time interval between call to the emergency services and ECPR team arrival Successful guide wire placement [ Time Frame: Up to 30 minutes after cardiac arrest ] The proportion of potentially supportable patients in whom guidewire placement is attempted and achieved Incidence of ECPR-related complications [ Time Frame: Duration of ECMO run, between 3 - 14 days ] Assessment of ECPR-related complications, such as incidence of vascular damage, haemorrhage requiring transfusion and new organ dysfunction

2018 Clinical Trials

17. Bivalirudin vs Heparin in ECMO Patients

on ECMO who are anticoagulated with Heparin and Bivalirudin. Patients will be anticoagulated with a heparin bolus at the commencement of ECMO per standard of care, as there will be insufficient time to randomize these frequently emergent patients. Consent for the study will be obtained from a legally authorized representative Prior to starting a continuous infusion of maintenance anticoagulation, patients will be randomized to bivalirudin or heparin. Outcome measures are bleeding, thrombosis (...) a circuit exchange [ Time Frame: 30 days ] Will be determined by total number of circuit exchanges needed in ECMO circuit due to thrombosis. Circuit exchanges may be done due to lack of adequate gas exchange or increased resistance pre and post oxygenator >50mmHg, circuit thrombosis or failure requiring emergent decannulation Thrombotic events [ Time Frame: 30 days ] Collect number of thrombotic events, defined as any of the following events; embolic strokes, embolic end-organ ischemia, embolic ischemia

2018 Clinical Trials

18. Preserving ECMO Cannulae Patency (PubMed)

Preserving ECMO Cannulae Patency Extracorporeal membrane oxygenation (ECMO) is often managed using minimal anticoagulation. This can make the circuitry susceptible to thrombosis. The ECMO cannula may be particularly vulnerable to thrombosis if flow is interrupted for an undetermined but prolonged period of time. Therefore, under conditions where cannula blood flow stasis may be prolonged and flashing, the cannulae is not an option (e.g., air in circuit) it is imperative to have an emergency

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2018 The Journal of extra-corporeal technology

19. A case of blunt thoracic aortic injury requiring ECMO for acute malperfusion before TEVAR. (PubMed)

malperfusion and subsequent acute severe ischaemia in the distal portion of the thoracic descending aorta was overcome by veno-arterial extracorporeal membrane oxygenation (VA ECMO) as a bridging therapy until the initiation of TEVAR.An adult woman was transferred to our emergency room after injuries sustained by falling from height. Her vital signs were unstable on admission. CT examination revealed the multiple injuries: traumatic subarachnoid haemorrhage, severe unstable pelvic fracture, and a grade III (...) A case of blunt thoracic aortic injury requiring ECMO for acute malperfusion before TEVAR. Blunt thoracic aortic injury (BTAI) is associated with a high mortality rate and the paradigm of treating patients with BTAI currently favours thoracic endovascular aneurysm repair (TEVAR) if possible. In BTAI, lethal malperfusion caused by a pseudoaneurysm has rarely been reported. We present the first report of a successful case in which a pseudoaneurysm causing the infrequent occurrence of lethal

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2017 Scandinavian journal of trauma, resuscitation and emergency medicine

20. ECMO in Cardiac Arrest PechaKucha

ECMO in Cardiac Arrest PechaKucha ECMO in Cardiac Arrest • LITFL • PechaKucha Cardiology Emergency medicine and critical care medical education blog Search LITFL ... | | | ECMO in Cardiac Arrest , last update August 29, 2018 PechaKucha presentation on the use of ECMO in the emergency department for refractory ventricular fibrillation in cardiac arrest Reader Interactions Leave a Reply This site uses Akismet to reduce spam. . Recent Posts Footer LITFL posts by or LITFL Review by or FFFF

2016 Life in the Fast Lane Blog

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