[cs_content][cs_section parallax=”false” style=”margin: 0px;padding: 45px 0px;”][cs_row inner_container=”true” marginless_columns=”false” style=”margin: 0px auto;padding: 0px;”][cs_column fade=”false” fade_animation=”in” fade_animation_offset=”45px” fade_duration=”750″ type=”1/1″ style=”padding: 0px;”][cs_text]We wrote recently about the need for excellent code team choreography – we’re lucky to work with a fantastic group of EM physicians, ED-intensivists, nurses, techs, and pharmacists who all come together to make it work when we receive a critically unwell patient.
One of the services we can provide to our out-of-hospital cardiac arrest (OOHCA) patients is extracorporeal cardiopulmonary resuscitation (ECPR) – placing the refractory cardiac arrest patient onto VA-ECMO in order to allow restoration of circulation and management of the inciting event. Appropriate ECPR patient selection patient selection is critical to ensure the best possibility of a good outcome.
The emergency department is a crucial part of the process. Our ED and ResCCU team are the first to assess and manage the patient, and hence in a pivotal position to make the decision to activate the ECPR team or not.
We have clear ECPR inclusion criteria in the ResCCU:
- Age <75 years
- Witnessed arrest
- Bystander CPR within 5 minutes
- High quality ACLS for 20 minutes
- EtCO2>10mmHg
We had a chance to demonstrate this a few weeks ago at the University of Pennsylvania’s Adult ECMO Symposium. We put together a simulation of an OOHCA patient and ran through the initial pre-brief; role-assignment; receipt of the patient; procedures including placement of the LUCAS device, femoral arterial and venous access, and insertion of a trans-esophageal echo probe to guide resuscitation decisions; and finally, the decision to proceed with ECPR. As you see in the video (credit to Felipe Teran MD), the team leader in conjunction with other team members will ensure that the patient is an appropriate ECPR activation.
The key to success is to do this the same way every time – repetition breeds familiarity, familiarity breeds confidence.[/cs_text][/cs_column][/cs_row][/cs_section][cs_section parallax=”false” style=”margin: 0px;padding: 0 0px 45px;”][cs_row inner_container=”true” marginless_columns=”false” style=”margin: 0px auto;padding: 0px;”][cs_column fade=”false” fade_animation=”in” fade_animation_offset=”45px” fade_duration=”750″ type=”1/1″ style=”padding: 0px;”][cs_text][x_video_embed no_container=”true”]
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Your addition to our health care system in any way is impressive and always an improvement. My small concern is that you mention a few disciplines of our medical but never mentions Registered Respiratory Therapists who are a very important and play a vital part in any life resuscitation situation. I’m not sure which “tech” is mentioned in this article. It is impressive.
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