Thread by @PulmCrit

ECMO has been around since the 1970s. this image shows a successful ECMO run! however, ecmo in the 1970s wasn't generally awesome.
- @iceman_ex at #HRreloaded

- current ECMO: portable, may be started in the field.
- remainder of talk will focus on venovenous ECMO.
- @iceman_ex at #HRreloaded

does ECMO work?
- CESAR trial: transport to ECMO center improved survival. Controversial b/c many patients didn't actually get ECMO.
- EOLIA trial: stopped early, but bayesian re-analysis suggested may be positive after all ?!?
- @iceman_ex at #HRreloaded

UK - at baseline, 5 referral centers with 30 ECMO beds (currently more due to COVID).
- @iceman_ex at #HRreloaded

cameo appearance by @DGlaucomflecken !
how much peep? ALL THE PEEP
(although maybe that's not fantastic for the right ventricle)
- @iceman_ex at #HRreloaded

hemodialysis used to be restricted to a few centers, but now it's widely available everywhere.
- @iceman_ex at #HRreloaded

evidence-based division between high- vs low-volume center might be as low as 6 cases per year, per ELSO
- @iceman_ex at #HRreloaded

lack of proven benefit for ECMO?
There is no proven benefit for much of what we do in the ICU !
- @iceman_ex at #HRreloaded

expense? ECMO appears to be more cost-effective than hemodialysis.
- @iceman_ex at #HRreloaded

lack of a destination can be a problem, but this is often our fault if we cannulate the wrong patients.
- @iceman_ex at #HRreloaded

selection of appropriate candidates up front can be tricky. which patients would do OK without ECMO?
- @iceman_ex at #HRreloaded

evolution of ECMO - might we reach a point where we could move directly to awake ECMO to minimize ventilator-induced injury?
- @iceman_ex at #HRreloaded

outcomes from ECMO at Segun's center (2 deaths from ICH, 2 from refractory organ failure, most survived!)
- @iceman_ex at #HRreloaded