Resuscitative Extra-Corporeal Life Support for Cardiac Arrest (ECMO)
Joe Bellezzo, MD along with his partner-in-crime, Zack Shinar, MD have started an ED ECMO service at Sharp Memorial Hospital in San Diego. I am so jealous! In this episode of the podcast, I get to talk to Joe about how it works.
What is ECMO?
ECMO is actually a misnomer. Extra-corporeal life support (ECLS) is probably a better term. If a catheter is placed in a major artery and a major vein (VA ECMO), the patient can be provided with full hemodynamic and respiratory support, aka cardiopulmonary bypass. If catheters are placed in two major veins (VV ECMO), the patient’s respiratory status can be maintained, but without the hemodynamic augmentation. Dr. Bellezzo’s shop is using VA ECMO to treat refractory cardiac arrest patients.
This is not the first attempt to use ECMO in this patient group, (see the articles in the EMCrit Hypothermia/Post-Arrest Section) but I think this is the first ED physician initiated service.
Which patients are they crashing on to ECMO?
What are the stages to placing a patient on ECMO?
Stage I-get catheters into a femoral artery and femoral vein
Stage II-exchange these catheters for the enormous ECMO catheters vias guidewire and serial dilations
Stage III-attach them to the ECMO machine, which is run by specially trained ICU nurses for the first 45-60 minutes and then by a perfusionist.
Don’t you have a video?
Dr. Bellezzo was kind enough to let me post this video