EDECMO.org is a non-commercial source to discover the life-saving potential of resuscitative extra-corporeal membrane oxygenation (ecmo) and extra-corporeal life support (ecls). We will teach you the skills and break down the logistics to allow resuscitationists to initiate ECMO in the ED or ICU.
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The FlightCrit Podcast. Sharing the latest education for Prehospital, Emergency, and Critical Care Trasport Professionals. We're passionate about providing the very best education for you, so please join us for the best in Clinical Practice Updates, Board Certification Exam Prep, Test Taking Tips, and much more. Have a topic you want discussed on the podcast? Let us know at www.askflightcrit.com Because What You Do Matters!
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87 – Pearls From Prague and San Diego Resus Consortium with Saul Levine
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This month Zack gives some pearls from his travels to Prague for Jan Behlolavek’s ECPR school, Poland to meet with Marek Dabrowski, and ELSO with the entire crew. Zack also interviews Saul Levine for the first of what may be a recurring conversation about the San Diego Resuscitation Consortium. His efforts along with Kristi Koenig, Shawn Evans, Tod…
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This episode is a follow up to last month’s episode with Nichole Bosson. Zack interviews Vadim Gudzenko about the in-patient aspects and critical care doctor perspective on the Los Angeles OHCA ECPR program. A few take homes are that EMS is critical to any OHCA ECPR program. Nurses need support for these intense patients with high mortality. And em…
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85: Los Angeles County ECPR Program with Nichole Bosson
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One of the biggest questions in ECPR right now is how do we organize our system to provide ECPR in an effective and streamlined approach? Nichole Bosson, Dave Shavelle and the army of L.A. ECPR enthusiasts have successfully implemented a multi-hospital ECPR receiving center program in Los Angeles. In this episode, Zack talks with Dr. Bosson about h…
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84: Talking ELSO with CEO Christine Stead
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Jon Marinaro takes EDECMO through another great podcast. This time he interviews Christine Stead, the CEO of ELSO. She talks about how ELSO is setting up standards for ECMO programs to try to make ECMO care at all hospitals safer. She talks about how she works also with the device industry. This involves working with the FDA for future innovations …
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83: Taking ECMO in Pulmonary Embolism to the Next Level
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In this episode Jon Marinaro joins the ED ECMO team and interviews his colleague Sundeep Guliani, MD about the use of an ECMO first strategy for Massive Pulmonary Embolism. Jon and Sundeep review the data and processes from their institution and from other institutions in the United States. Could it be that ECLS could move the survival needle on th…
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In this episode, Jon Marinaro and Zack Shinar go through the hot off the press Inception trial. The trial was touted as a negative ECPR study though many reasons make this trial different then the ARREST trial. They go through several important take home points for practitioners starting or running an ECPR/ECMO program. Inception Trial https://www.…
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81: In Hospital Cardiac Arrest ECMO Inclusion Criteria with Joe Tonna
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In this podcast, Joe Tonna tells us how to approach hypothermia with ECPR patients. He also goes through his paper RESCUE-IHCA giving us an immediate way to prognosticate in patients to use of ECMO or not. Hypothermia – Resuscitation Nakashima T, Ogata S, Noguchi T, Nishimura K, Hsu CH, Sefa N, Haas NL, Bĕlohlávek J, Pellegrino V, Tonna JE, Haft J,…
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025: Bringing Back The Dead: eCPR w/ Dr. Zack Shinar
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In this episode of the podcast, we sit down with Dr. Zack Shinar of the EDECMO Podcast, and co-author of "ECPR AND Resuscitative ECMO," the world's first ECMO CPR textbook. Dr. Shinar is a world-renowned expert on ECPR and resuscitative ECMO, and he was gracious enough to share a bit of his time with the FlightCrit community. In this episode Dr. Sh…
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80: The Expert Approved ECPR Procedure with Florian Schmitzberger
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In this episode, Zack interviews Florian Schmitzberger who just published a fantastic study that incorporates fourteen leaders within the ECPR community to hash out the specific procedural steps associated with ECPR. INCLUSION • Age <75 years • Witnessed arrest • Initial rhythm is shockable rhythm (VF / VT) • ECPR can be initiated within 60 minutes…
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79: Prolonged Arrests and the Denmark Experience
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This month Zack gives a few pearls from the recent Reanimate courses and annual ELSO meeting in Boston before he interviews Gowry Mork from Aarhus University about her fantastic recent paper. Pearl #1 is about hand placement in cannulation. Hold the ultrasound in your left an d needle in right. Once in the vessel, drop the US probe and take your le…
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024: Keeping the Massive PE Patient Alive w/ Dr. Haney Mallemat
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In this episode, we're joined by Dr. Haney Mallemat from @critcarenow to discuss the patient with a massive pulmonary embolism and how we need to manage these patients in the acute phase to keep them alive until we can get them to definitive care. Below are several resources Dr. Mallemat referenced in our talk, as well as links to Critical Care Now…
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This month we are honored to have Neville Vlok on the show. Neville has been one of the key physicians pushing for ECPR in South Africa. In this episode, we explore what medicine and resuscitation looks like in South Africa, how ECMO has been utilized, and whether ECMO even makes sense in developing countries. Vlok N, Hedding KA, Van Dyk MA. Saved …
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023 - Antepartum and Postpartum Hemorrhage w/ Ami Bess, BSN, CCRN
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Join us for an exciting talk with our friend and colleague Ami Bess, Chief Flight Nurse for UCHealth LifeLine about one of the most unnerving topics in Adult Critical Care Transport - Management of the HROB patient with severe Antepartum & Postpartum Hemorrhage. Topics discussed in this episode include Assessment of the patient with severe Antepart…
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022: TXA and Whole Blood Resuscitation with Dr. Andrew Fisher
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In this episode of the podcast, we discuss some new ideas about the use of TXA as well as provide some new insight into the use of Whole Blood Resuscitation. Links to articles mentioned in the podcast coming. Support the show Medic and RN CE's available over at academy.flightcrit.com
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021 - Vent Management: Optimizing Flow w/ Joe Lewis, The Respiratory Coach
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In this episode of the podcast Hunter and I sit down with Joe again to discuss the role of optimizing Flow in our mechanically ventilated patients, and how to manipulate this on our vents. We also discuss some of the risks associated with certain vent modes for patients who Flow Hunger and one strategy for correcting ventilator asynchrony. We highl…
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020: Initial Stabilization of the Multi-system Trauma Patient w/ Dr. Jermey Kaswer
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In this week's class, we talk with Dr. Jeremy Kaswer, better known as @TacTraumaMD, about his approach to the initial stabilization of the poly-trauma patient. From Assessment to Chest Tubes, Shock Index to REBOA, Dr. Kaswer shares his experience as an ED physician, Army Flight Surgeon, and Critical Care Fellow at SHOCK Trauma with our community. A…
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Using ECMO for traumatic patients has had some promising papers through the years, but the data overall is still poor. Justyna Swol has teamed up with ELSO to improve this deficiency by making a trauma carve out of the ELSO registry. In this episode, Zack discusses with Justyna the many facets of ECMO in trauma. A few pearls and references are belo…
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019: Endocrine Emergencies: Adrenal Disorders
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In this episode of the FlightCrit Podcast Hunter discusses Adrenal Emergencies. Support the show Medic and RN CE's available over at academy.flightcrit.com
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018: The Basics of Chest X-Ray Interpretation
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In this episode of the FlightCrit Podcast Hunter introduces the fundamental concepts of interpreting a chest x-ray, an essential skill for all critical care and transport providers to master. This episode relies heavily on the visuals to support the concepts presented, so we recommend watching the video of this presentation over at academy.flightcr…
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76: Netherlands Pre-Hospital ECPR Program
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The Netherlands has undertaken a monumental task: provide ECPR to 100% of their country. Dinis Reis Miranda and his team have put in place an unbelievably organized and robust project to improve the survival from cardiac arrest for their entire country. Listen to Dinis explain about the project, their struggles, and this world changing experiment g…
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017: Managing the Crashing Heart Failure Patient w/ Dr. Connvissar from "Count Backwards from 10"
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In this episode of the FlightCrit Podcast we chat with Dr. David Convissar, Critical Care and Cardiothoracic Anesthesiologist, from "Count Backwards from 10" about his approach to managing the airway of the crashing heart failure patient. Hang on as Dr. Convissar shares with us his knowledge about: Differentiate between cardiogenic shock and distri…
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016: Lung Compliance and Optimizing PEEP w/ the Respiratory Coach
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Mechanical Ventilators, such as the Hamilton T1, ReVel, and ZOLL Z-Vent, are not only vital pieces of equipment used in the ICU and in Critical Care Transport, but they are becoming more popular for use by EMS services for interfacility transport so it's vitally important that EMS and Critical Care providers have a deep understanding of not only ho…
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015: Oxygenation, Ventilation, and Driving Pressures
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In this episode of the podcast, I'm joined by my co-host Huster as we discuss the physiology of Oxygenation, Ventilation, and Driving Pressures as they related to the Mechanically Ventilated patient. https://academy.flightcrit.com/courses/oxygenation-ventilation-and-driving-pressure Support the show Medic and RN CE's available over at academy.fligh…
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EVDs, External Ventricular Drains. What are they, how are they managed, and what should we know about them if we happen to see one in transport. Support the show Medic and RN CE's available over at academy.flightcrit.comBy Sean Eaton, FlightCrit LLC.
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In this short episode, Zack makes two points. One, it was tough to get to where we are with ECMO acceptance. Two, cardiac arrest patients in PEA should be considered for ECPR. Below is the full editorial Zack and Alice did recently in the Journal of Resuscitation on the topic. It was born out of a fantastic German article centered looking at regist…
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74: Do 70 year old’s deserve ECPR? A Deep Dive into the Economics of ECPR
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Have you ever pondered whether all the work over ECPR was worth it? Even if you did save a few patients, does this really make sense from a societal standpoint? Am I giving up my life on a project where my efforts could be better elsewhere? Then this episode is for you (and me). This month I talk with Melissa Barnes and Ryan Coute about the economi…
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73b: Conclusions for Hyperinvasive Trial with Jan Belohlavek
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Here is the conclusion for the interview of Jan Belohlavek and his Hyperinvasive TrialBy Zack Shinar, MD
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73:The Hyperinvasive Trial with Jan Belohlavek
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Wait...ECPR works?To the believers, this has been a foregone conclusion. To the rest of the world, the question of whether ECPR improves cardiac arrest survivorship has been in question. Jan Belohlavek and his Prague colleagues just presented their 8 year data showing better outcomes in cardiac arrest patients that got a grouped therapy of early tr…
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Heparin has been the mainstay of anticoagulation for ECMO patients for years. In recent years, this has been challenged. Bivalirudin has become a potential better anticoagulant. Troy Seelhammer in EDECMO episode 55 gave us some insight into this. This month Ryan Rivosecchi and his crew at UPitt have released their findings in Critical Care Medicine…
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71: Should We Prioritize VV-ECMO over ECPR?
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In this episode, we dive into the abyss of resource allocation. Much of the world is saying that the limited number of ECMO circuits should be used for COVID induced lung injury. This means that ECPR initiatives have been shut down or severely limited. Is this the right thing to do? What does the data say? What strategy gives the most benefit to th…
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70: REBOA REDUX – Management of Hemorrhagic Shock in Non-Trauma Patients – with Bellezzo & Zaf Qasim
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In this episode Joe Bellezzo talks with Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) expert Zaf Qasim about NON-TRAUMA applications of aortic compression for control of non-compressible non-trauma torso hemorrhage.By Zack Shinar, MD
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2020 was a crazy year. This month Zack goes through the biggest ECMO lessons learned in 2020. This is a short concise run through of ECPR, ECMO for COVID, Imaging, and Aortic Dissection. It's a reminder of how organization is so critical to the outcome of your ECMO program. He also reminds us how improvement in these systems of care can lead to sur…
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68: ARREST – The First Randomized ECPR Trial Ever
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The ARREST Trial is published! Demetris Yannopoulos, Jason Bartos and their army of rockstars have done it! This is the first randomized ECPR trial and it showed tremendous benefit of ECPR compared to traditional therapies. Zack explores this paper and their concurrent publication of process with Demetris. Their two Lancet papers are belowhttps://w…
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67: Da DO2: Fundamental ECMO Physiology with Sage Whitmore
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Have you ever wondered about how initiating ECMO changes the cardiovascular physiology? Have you wondered what metrics you should be looking at when resuscitating a patient that has a beating heart and a ECMO flow? Dr. Sage Whitmore, an ED Intensivist from Nashville with ECMO training from UMichigan, leads us through the basic to the tough question…
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Have you ever wondered how you would crash someone onto VV ECMO? Have you ever wondered where is the best place to put the cannulas? Have stayed up late at night wondering which patients in your department could benefit from VV rather than VA ECMO? Then this is the episode for you!! After a few recent cases of crash VV ECMO in our hospital, we have…
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65: ECPR Journal Club: Dual Sequential Defibrillation, CT after ECMO, and much, much more
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This month we tackle a number of topics. Garrett Sterling is back again with Zack Shinar to talk about cutting edge resuscitation, ECMO, and the interplay between the two. Dual sequential defibrillation, CT after ECMO initiation, should you perform bystander CPR in the era of Covid, some US ECMO data, and an awesome 3D modeling for ECPR training mo…
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64: Contraindicated??? – Long Live the Aortic Dissection with Garrett Sterling
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In this episode, Zack Shinar introduces a new physician to the podcast - Garrett Sterling. Garrett and Zack discuss the sticky topic of ECMO for aortic dissection. This traverses everything from VA ECMO in ECPR to VVECMO for pulmonary edema. They go through the literature on the subject and make some conclusions based on this data. The ultimate que…
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63: Covid and ECMO – Who do we cannulate? with Jenelle Badulak
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"Normal life is changing. It is now a covid 19 life" - Bin CaoI write this with some trepidation as well as pride in the role we get to play as we begin the surge of Covid 19 in the United States. Today we will address the use of ECMO in Covid with an expert in ECMO who is in the throws of the worst outbreak of the United States - Seattle, Washingt…
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62: Jason Bartos Take 2: The Future of ECPR Now
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Last month you heard Jason talk about the ECPR program at the University of Minnesota. This month Zack and Jason talk about post initiation care and the crazy ECPR realities that Demetri, Jason and U of M have created. The sky is the limit for their team!By Zack Shinar, MD
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Jason Bartos and his crew at the Universityof Minnesota have revolutionized the concept of ECPR for out of hospital cardiac arrests. His crew are interventional cardiologists who take OHCA straight to the cardiac cath lab. They have initiate times of around 6-8 minutes and have neurologically intact survival rates higher than 30%. Below are two of …
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Today's episode focuses on the differences between ECMO physiology in the patient in cardiogenic shock versus the one in cardiac arrest.By Zack Shinar, MD
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59: Partial REBOA and US PreHospital ECPR Revisited
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This month we discuss two different topics we've recently had on the podcast. Albuquerque had started the first US prehospital ECPR program.... and now they have the first patient as well. Jon and Darren will share with us the exciting news. Second, we recently had Matt Martin on the podcast talking about partial REBOA. We got tons of email about t…
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The U.S. has seen pre-hospital programs spring up in Paris, UK, and Australia. It was thought that due to billing issues this could never happen in America....but it has. Jon Marinaro and Darren Braude have accomplished this against all odds. Zack interviews the two of them on how they were able to accomplish this task amidst the many financial, lo…
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57: The New REBOA catheter – Perfecting the Partial Occlusion
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Over the last two years, partial or intermittent REBOA has beenthought to be a significant advantage over complete REBOA. How to do this and how to use our current imperfect catheters in this arena is still in question. Matthew Martin and his colleagues at Madigan Medical Center have published the first study using the Prytime's new catheter for pa…
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56: Pressors, Fluid, or Flow – Optimizing ECMO Physiology
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A post arrest patient just got initiated on ECMO. Do you give fluids, add pressors, or increase flow? Marc Dickstein, an anesthesiologist from Columbia University and an expert in the physiology of ECMO, talks with Zack about how to manage these patients, what diagnostics we need and how to optimize your use of the machine. This talk is a must for …
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55 – Anticoagulation of the ECMO Patient with Troy Seelhammer
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Do you give heparin to your ECMO patients? Well, let's rethink this. This episode is All Things Anticoagulation! Zack talks with Troy Seelhammer, an intensivist from Mayo Clinic Rochester. He manages ECMO patients in his daily practice there. He has become a master of the subject of anticoagulation. He will talk about heparin, bilvalirudin, or mayb…
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54: Confirmation of Wire Placement with Sacha Richardson
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In this episode, Sacha Richardson talks with Zack about a problem common to all ECPR programs- how do we confirm the placement of the wires? During chest compressions and even in patients with a pulse, confirmation of which vessel you have cannulated can be difficult. Sacha shares some tricks and trips on how to get real time confirmation of the wi…
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53b: Resuscitationist Inserted Distal Perfusion Catheter with Chris Couch
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In this episode, we again explore the world of the distal perfusion catheter. You heard from Joe Dubose the vascular surgeons point of view; now let's see how non-surgeon resuscitationists are dealing with this problem. You will hear from Chris Couch, a critical care trained emergency physician from Dallas Texas and his colleague Omar Hernandez who…
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53: Distal Perfusion Catheter with Joe Dubose
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Episode 53 is all about the distal perfusion catheter12. We are inserting a 15-19 Fr catheter into the femoral artery. This limits the flow of blood to the affected extremity. Many institutions have gone to mandatory distal perfusion catheters. This episode is all about those catheters - when, how, which, and where. Joe Dubose, the world reknown va…
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52: Brain Freeze- Selective Retrograde Cerebral Perfusion for Intra-Arrest Neuroprotection
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We've all heard of therapeutic hypothermia. Some of us have heard of deep hypothermia for traumatic arrest. But what about deep regional hypothermia of brain for cardiac arrest! Zack interviewed Rob Schultz, a CT surgeon resident from Calgary who is doing research on deep hypothermia of the brain using some of the tactics that are utilized in opera…
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