Cite this post as:

Scott Weingart, MD FCCM. EMCrit 332 – Procedural Errors I See at the REANIMATE ECPR Course and How to Place an Intra-Arrest Femoral Arterial Line. EMCrit Blog. Published on September 11, 2022. Accessed on May 15th 2025. Available at [https://emcrit.org/emcrit/procedural-errors-at-ecpr-course/ ].

Financial Disclosures:

The course director, Dr. Scott D. Weingart MD FCCM, reports no relevant financial relationships with ineligible companies. This episode’s speaker(s) report no relevant financial relationships with ineligible companies unless listed above.

CME Review

Original Release: September 11, 2022
Date of Most Recent Review: Jul 1, 2024
Termination Date: Jul 1, 2027

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don zweig
don zweig
2 years ago

thanks for this. I have always pulled the wire out of the holder and nice to hear im not alone. btw, which Pajunk needle to you use for vascular access?

What's Your Job?
ed doc
James Kelley
James Kelley
2 years ago

Excellent podcast. Attended the course 3 years ago. Great course. Have been teaching my med students and residents vessel trigonometry for years. It really helps their spatial orientation with short axis ultrasound view in placing lines. Thank you Scott.

What's Your Job?
ED doc
Barret Zimmerman
Barret Zimmerman
2 years ago

Why is the technique different for A lines? E.g. why the “dart” hand position, why does Scott say in his first microskills video he takes the wire out entirely for A lines?

What's Your Job?
EM resident
Barret Zimmerman
Barret Zimmerman
2 years ago

And why no syringe for A lines? I do these same adjustments but now it’s occuring to me to ask why the technique and equipment isn’t the same.

What's Your Job?
EM resident
Sandra Ockers
Sandra Ockers
2 years ago

Great podcast especially the part about using a central line needle for femoral art lines. I tried to get CME for this episode but the link is not working. It just takes you to the same picture. Can this be fixed? Thanks!

What's Your Job?
Physician Assistant
Guramrinder Thind
2 years ago

Hi Scott. Curious about your take on using an angiocath vs needle (we have the long 2.5 inch 20 Ga and 18 Ga Introcans).

Also, do you routinely pause CPR while getting access? Thanks.

-Aman.

What's Your Job?
Intensivist
Last edited 2 years ago by Guramrinder Thind
Brent Klapthor
Brent Klapthor
2 years ago

I was debating this recently with a coresident. Do you happen to have a citation on any studies that show this evidence on angiocath vs bare needle? Thanks!

What's Your Job?
ER Resident
Frédéric Lemaire
Frédéric Lemaire
2 years ago

Fantastic Episode !!! Disclaimer : I’m an ED doc from the EZ-IO and peripheral pressor era, i’m far from an expert in line placement 😉 Just messing around with some ideas 1) Vein cannulation and syringe With ultrasound do you really think that the syringe is still valuable ? The “dart method” is so stable, so precise. I think, There’s an argument to be made that the syringe is a remnant artifact from the pre-ultrasound era 😉 haha Seriously, i’m not sure i see great value, especially for an ED Doc that rarely put central lines. The dart method is… Read more »

What's Your Job?
ED Doct
Frédéric Lemaire
Frédéric Lemaire
2 years ago

Nice Tips !!! Thanks
Sorry i missed the tilting in the podcast.
Fred

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ED
Matthias Rosenbaum
Matthias Rosenbaum
2 years ago

Awesome episode but it was the first time I heard of the downsides of the „wire holder“. Your argument totally makes sense, especially getting the wire right into the vessel in one movement.
Could you, if there is any time, show us a video of someone doing it correctly? Our central line wires all have this „mini pigtail“ so the little introducer which keeps the wire straight and connects to the needle hub is still necessary.

What's Your Job?
Anesthesist
Chris
Chris
2 years ago

Having started to place ECMO in multiple scenarios and then listening to this amazing episode, I realized a few things:

1) my ultrasound-guided needle placement sucks and needs improvement
2) the first time someone told me where the perfect spot for the vessel puncture lies: 2cm above the bifurcation but below the inguinal ligament
3) placing a stiff wire directly into a 7F introducer sheath is bs

thank you for teaching me this, no one ever did before

What's Your Job?
cardiac surgeon
Michael Prats
Michael Prats
2 years ago

Excellent pointers, learned a lot. Wanted to comment on the “trigonometry” method. Works well for the experienced, but I don’t like to see this in early trainees. I call this the “point and shoot” method – where you mentally estimate these distances and hope everything lines up as planned. It is surprising how often you can lose a needle even over a short distance unless you are astutely attuned to its appearance/movement on ultrasound. This can be a challenge for the uninitiated and invite unnecessary delays/complications. I teach and much prefer your second method whereby you note the distances, then… Read more »

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Emergency Physician, Ultrasound Educator
Jan Benes
Jan Benes
2 years ago

Hey, Scott,
thanks for a great podcast. I was wondering exactly which Pajunk needle you were referring to. In our distribution (Czechia, Europe) there is only the Tuohy needle tip or the 18G over the needle e-cat catheter with the 20G needle. Neither could I find anything in the international catalog. The visibility of Pajunk needles is indeed superior to anything else, we use them for regional anesthesia. It would be great to get them.
Thanks

Jan Benes

What's Your Job?
ICU consultant
thomas fiero
thomas fiero
2 years ago

very cool pod, Scott. thank you. in march 2017 I took the Reanimate course. had no idea what the heck I was doing generally. you showed me femoral line placement.(I barely knew central lines)… but Reanimate (that one was #3) is much much more than learning ECMO. It is a whole mindset. paradigm for major resus. reboa. placing 19 and 24 French fem lines. and meeting an international family of teachers and “students” from Lionel and Alice form France, others from Scandinavia, Australia , and more. it’s technique, and science, but also an attitude. that we got this. way above… Read more »

What's Your Job?
ed doc, merced, cali
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