Thread by @manalalasnag

1/9 🅲🅰🆂🅴-🅱🅰🆂🅴🅳 🆃🆄🆃🅾🆁🅸🅰🅻 4
MECHANICAL CIRCULATORY SUPPORT

@ACCinTouch @agtruesdell @ErikOsborn77 @mirvatalasnag #ACCIC #PedsCICU #PedsCards

🔹Background
🔹#PedsICU #ECMO Case
🔹Adult ECMO + #Impella Case
🔹Upcoming Webinar

2/9 EARLY RUNS OF #COVID19 PATIENTS ON #ECMO

Initial discouraging reports from 🇨🇳
Warning of igniting immune storm esp in patients with high IL-6

Nationwide centralization in 🇯🇵 to improve research & quality of evidence
🔹Time to ECMO
🔹Lung compliance
🔹Biomarkers

3/9 GUIDANCE DOCUMENTS

Surviving Sepsis Guidelines
🔹VV ECMO for refractory hypoxemia despite optimizing ventilation rescue therapies & proning
🔹Intensive Care Med May 2020
doi:10.1007/s00134-020-06022-5
@AlhazzaniW

FDA Enforcement Policy expanded availability of devices

4/9 ELSO INTREM GUIDELINES

doi: 10.1097/MAT.0000000000001193.

🔹ECMO deployment costs & strain
🔹patient selection is key
🔹potential devastating complications
🔹long-term functional outcomes
🔹decision is not straightforward!

Crisis Response:
doi: 10.1378/chest.14-0732

5/9 CYTOKINE STORM

🔹delayed immune response
🔹pancarditis reported
🔹shock required ECMO 🔹Immunephenotypes
🔹inborn errors of immunity 🤔

doi.org/10.1038/s41577…

doi.org/10.1038/s41577…

6/9 ELSO DASHBOARD

#COVID19 #ECMO
bit.ly/COVID19Reg

3 nested tables for patients at different stages of care:

🔹ALL including those still on ECMO
🔹cases completed ECMO run
🔹cases discharged from hospital

7/9 #PedsICU CASE

🔹18 yr dyspnea & fever
🔹NIV ->intubated + Proned
🔹MV failure pneumo & hemothorax
🔹VV ECMO Avalon 31Fr RIJ
🔹Severe RV dysfunction
🔹VVECMO Bridging Strategies

CREDIT:
Dr Mara Scandroglio 🇮🇹
IRCCS San Raffaele Scientific Institute
@alaide_chief

8/9 ADULT CASE

(VAECMO + IMPELLA) to (biVAD)

🔹44y CP SOB + #COVID19
🔹CXR scattered ground glass
🔹ECHO LV dilated dysfx
🔹VA ECMO
🔹LV worsening MR >> Impella
🔹myocarditis > biVAD + oxygenator
🔹Appropriate support is lifesaving!

protectedpci.com/treatment-of-a…
@ProtectedPCI

9/9 UPCOMING WEBINAR .. JOIN US!

August 5th @ 08:00 🇺🇸 15:00 🇸🇦

Role of Mechanical Circulatory Support During the #COVID19 Pandemic

@mirvatalasnag @manalalasnag @FrederickWelt @AdelTash @alaide_chief @PerwaizMeraj @ErikOsborn77

Registeration⤵️
acc.org/education-and-…