Roger Pye is a world leading ECMO specialist. This talk on starting ECMO during CPR resuscitation is serious and backed up by some extraordinary cases. Roger presents his experience and the literature on this topic.
The presentation can be heard on wwwintensivecarenetwork.com.
127. ECMO During
Witnessed Cardiac Arrest
• Decide Early into Arrest
• 1/3 Survive to Discharge (2x CPR)
• 80% with OK Brain
• Median Survival 9-10 years
128. ECMO During
Witnessed Cardiac Arrest
• Decide Early into Arrest
• 1/3 Survive to Discharge (2x CPR)
• 80% with OK Brain
• Median Survival 9-10 years
129. ECMO During
Witnessed Cardiac Arrest
• Cath Lab Good Spot to Arrest
• ECMO Decision 5-7 days
• Renal Failure is Bad
. 2008 : 53M. CP ER. Arrests in Resusc bay refractory VF despite 45 min CPR. ECMO referral 30 min
On VA ECMO by 53 min
. Emergency C Angio on ECMO and still in VF. 1hr 56min after arrest
. Heart improved. ECMO weaned 6 days. ICU 21 days ARF CVVHD,ischaemic hepatitis etc. Brain ? I thought quite “knocked off” – wife quite liked it. D/C home 45 days 5 months later good heart, mild brain injury but independant
. Persistent symptoms Cath lab late Friday arvo, just finished in cardiac OT. Pulmonary oedema and arrested on angio table. Intermittent CPR. VA ECMO – I beat the surgeon getting cannulas in – later perc BFC
. Ratty TVD surgery
. Rested on ECMO 4 days then CAGS. Post CPB IABP, inotropes. Heart recovered quickly but head too a long time. Extubated 11 days post op. D/C ICU 16 days post op, 20 days post arrest. Rehab 28 days post arrest
. Sad story 2010. 44M with young family, recent long haul plane flight. Thursday morning 0915 Arrested at home- found by wife fitting – prob hypoxic fit. ? No bystander CPR, 6min Ambulance, 50min ER, 45min VA ECMO
Heart looked pretty bad
. No cause determined. ECMO weaned 4 days
.Earlier this year: 48M Admitted with what was thought to a primary Respiratory illness intubation . After an initial delay confirmed Cardiac failure 2ndry to Significant valvular pathology
. His Mitral valve was highly abnormal
. Wide open MR . Also TVD. Needless to say he rapidly deteriorated one Sunday morning about 10 days into all this. Prearrest context of bolusiingAdren.
MN & myself put him on VA ECMO
. Subsequently the dust settled . 3 days later he had a triple Valve operation and CAGS transitioned back on VA ECMO wean in 24 hours. Prolonged ICU stay 33 days – trachy. D/C home 52 days