2018 UF ED/Trauma Symposium

1. Advanced Lung/ECMO Service
Joseph Shiber, MD, FACP, FACEP, FCCM
Associate Professor of EM, Neurology, and Surgery
ECMO Program Director

2. Program Started July 2017
 Total 28 patients referred
 26 patients evaluated
 1 patient’s family declined Trx to UF and 1 pt we declined due to >550 Lbs.
 All Jacksonville area hospitals have made referrals
 2 from Georgia
 7 patients placed on ECMO
 5 V-V: 3 blunt chest trauma and 2 Flu
 2 V-A: both cardiac arrests from severe hypoxia (one arrived in arrest)

3. Milestones
 We had two patients on ECMO at same time
 We cannulated two patients back-to-back
 We exchanged a circuit on a patient w/ clotted oxygenator
 Accomplished E-CPR
 Still able to Treat and Salvage ~75% of severe ARDS Pt’s w/o ECMO
 One referral for potential V-A : 18 y/o VF arrest
 Survival to D/C >80%

4. Three Phases of our Development
 Phase 1: Be able to rescue pt’s at UF Health
 Phase 2: Be able to receive pt’s from Jacksonville who need us
 Phase 3: Be able to go rescue pt’s in N Florida and SE GA

5. Recent Case: 21 y/o man MVC
 Restrained driver car split in two
 Not intubated by EMS but c/o SOB
 SQ air so L CT placed

6. Multiple Injuries
 Rib Fractures and Pulm Contusion L>R
 Mandible and facial Fx’s
 Occipital condyle Fx
 Sacral and pubic rami Fx

7. To OR for massive hemothorax
 Left Thoracotomy: L LL repair
 6.88/97/49
 Chest Re-opened for additional repair and packed
 Re-opened again for CARDIAC ARREST and L LL Lobectomy
 6.94/115/38 (while being bagged for prolonged period)
 ECMO Consult Paged Out from PACU

8. 25F Outflow and 23F Return Cannulas
 Fem – Fem cannulation
 Avoid IJ since skull base Fx
 Risk of Thrombosis and ICP

9. Excellent Separation

10. 7.44/45/67
 1st ABG 30 minutes s/p ECMO
 More efficient ventilation>oxygenation

11. Action Shots of the Team

12. ICU Course
 No heparin for 48 hrs as L Chest STILL OPEN
 Closed at bedside s/p packs removed
 PO2 steadily improved and APRV weaned “Drop & Stretch”
 REST SETTINGS 35% FiO2
 Coughing and suctioning old blood from lung injury
 CXR improving daily

13. Recirc (day 6)

14. Decannulated (day 7)
 APRV weaned to minimal so extubated on day 8
 Bilateral Flail Segments
 Reintubated and bedside trach next day
 On APRV minimal settings for another week
 Then HFNC via Trach
 ATC and complete liberation from MC
 Capped then Trach decanulated on floor

15. Summary
 We are rescuing Pt’s who would have previously died
 ARDS, Blunt Chest Injuries, Flu, Cardiac Arrest
 Survival BETTER than National Averages ~50-60%
 Organ SUPPORT/REST allows for RECOVERY
 We are ready to move on to Phase 3
 Planning + Teamwork = Success

16. Thank You to all of the ECMO Team!
 David Skarupa & Brian Yorkgitis
 Trauma/ACS Division
 Bennita Young
 Chuck Jerabek
 Travis Peistrup
 Amber Mason
 SICU Nursing
 Respiratory Therapy

17. Questions & Comments