Teddy Hla Profile picture
Oct 25 18 tweets 12 min read
NEXT Speaker : VA ecmo for which patients?

Severe cardiogenic shock has different phenotypes
1. medical cardiogenic shock(AMI, end stage dilated CM, myocarditis, septic shock)
2. Post cardiotomy refractory CS (post CABG)
@ESICM #ecmo #resuscitation #ALS
@ESICM 2022 what do the guidelines say
- ESC recommends short term MCS should be considred in cardiogenic shock.
IABP may be considered but not routinely recommended in post MI
What about in fulminant!myocarditis ? Mostly giant cell myocarditis #LIVES2022 Image
What about in cardiomyopathy patients?
- ECMO can be used as a bridge to heart transplant
- the other strategy is "bridge to bridge"
- 2 ecmo device for each L and R heart WOAHHHH!!
2 ecmo for 1 pt Image
ECMO has completely changed the way we manage heart transplant
- 20 years ago we dont have VA ECMO and not this rapidly
- e.g., RV failure post heart transplant.
- see below where ECMO pre Heart tx has almost as good outcome
Next : what about in life-threatening PE?
this is a difficult area.
timing is very important
- as part of resuscitation OR to stabilise severe haemodynamics OR in case of failed sys thrombolytics or catheter directed therapies.

#pe #massivepe #ecmo #LIVES2022
Of course any #ecmo talk won’t be complete without talking ARREST trial. Really good outcome. Image
Contrast this with Prague OHCA
- non significant outcome.

(massive differences -- @drizopoulos has an ECMO bus that goes to scene, amongst many others) PRague - pt brought to centre.

- AGE and COLLAPSE to ECMO time - KEY


#ecmo #ecpr #ALS #LIVES2022
@drizopoulos What about in "septic shock" - niche group


ECMO patient has higher probability of survival . mortality dropped from 85 to 45%
Hazard ratio of 0.24.

Time window is "very narrow" here too to note.

#ecmo #septicshock #LIVES2022
Again Ecmo chat needs to reference @SCAI criteria of CS. #LIVES2022 Image
But class E may not be the right patient group. Multi organ failure is major risk factors for not surviving Ecmo. We need to find right patient group perhaps in scai C D groups. #LIVES2022 #ecmo #ECMO Image
A few more trials coming and more results likely to come out soon over next few months and years.

Another trial in France ongoing with a different primary end point.

#ECMO #als #resuscitation #mcs
Q: what about using ECMO earlier not as a final rescue device but more commonly?
A: clearly we have to move on to earlier in disease process but we do need to work on early identification of this patient groups for both ecmo and impella
#ecmo #LIVES2022
Q: drug toxicity cardiogenic shock?
A: again if started early could have good outcomes. WE SHOULD NOT hesitate to start ECMO in 2022 -- this is so 2010. :P #ECMO #als #MCS #LIVES2022
@UnrollHelper unroll

• • •

Missing some Tweet in this thread? You can try to force a refresh

Keep Current with Teddy Hla

Teddy Hla Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!


Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @teddyhla

Oct 25
Carolyn Calfee Clinical and Biological phenotypes of ARDS
- what do they have in common?

ARDS : subgrouping since the begining
- sepsis vs. non sepsis
- hyper vs. hypoinflamm
- reactive vs uninflamed
#ventilation #ards #phenotypes #LIVES2022
Are clinical phenotypes biologically distinct?
looking at Trauma vs. Non trauma

ICAM-1 , SP-D, vWF, sTNFr-1 are different.
What about in "Direct" vs. "indirect"
or "Diffuse" vs "focal" -- sRAGE comes up again.

#ventilation #ARDS #LIVES2022
Read 13 tweets
Oct 25
Uppsala- Sweden
"Do we Need a biological definition of ARDS"

- Berlin definition has NO Diffuse alveolar damage .
- the Berlin defn does not capture well
Frohlich - different definitions specificity of 0.63, 0.42, 0.31 even!
#ventilation #ards #LIVES2022
The BJA article by Frohlich.
Fibrosis only starts after 7 days
Thille article : atsjournals.org/doi/full/10.11…
In essence, different disease processes are happening to the lung at different times in the "ARDS"
Read 14 tweets
Oct 25
ARDS - new definition or phenotypes by @GicoBellani refreshing with Kigali definition of ARDS - useful not just low resource but during pandemic in supposedly high income settings and only draw back is no PEEp requirement #ards #ventilation #LIVES2022 @ESICM
@GicoBellani @ESICM Resolved versus confirmed ARDS
- prospectively applying Berlin definition did work but if ya wait 24 hrs and re-measure P/F ratio, you end up stratifying much better.
- Better separation of groups

#ventilation #LIVES2022
@GicoBellani @ESICM Whichever definition - american european consensus or Berlin or Kigali -- all goes back to Ashbaugh original paper in 1967


Why are we so confused when it comes to ARDS definition ?

#ards #ventilation #LIVES2022 @ESICM
Read 12 tweets
Oct 25
Next : Mypinder SEKHON on cardiac arrest in COVID-19 era.

Works in Vancouver
COVID 19 era cardiac arrest ARE a lot less sexy with all the PPE. #als #covid19 #resuscitation #LIVES2022
@ESICM Let's look at epidemiology. Northern Italy, Manhattan - COVID hit hard and has impact on other diseases.

e.g., OHCA in Italy during COVID 19 massive spike.
Read 9 tweets
Oct 25
what about in refractory cardiac arrest?
ERC - ESICM guidelines 2021
- timing of CAG if no evidence ofr ST segment evaluation.

which means we will end up treating a lot of patients with stent and anticoagulation
TOMAHAWK trial : delayed or early invasive angiography -- no effec.

- immediate catheterisation for non ST elevationrr
Read 4 tweets
Oct 25
Updates on Advanced life supprot by Theresa OLASVEENGEN

Vasopressors and Drugs : recent trial outcomes.
@ESICM #als #resuscitation
@ESICM 2020 ILCOR consensus : strong recommendation to use "ADRENALINE" in cardiac arrest, if you dont have it "LIDOCAINE".

Adrenaline to placebo comparison is mainly 1 older trial with latest PARAMEDIC 2

@ESICM PARAMEDIC 2 - big study
8007 pts, adrenaline 4000, placebo 3999
- a lot of discussion post trial
- need a nuanced interpretation.
- 19 "more good" survivors and 5 "more bad" survivors in adrenaline arm.

Read 19 tweets

Did Thread Reader help you today?

Support us! We are indie developers!

This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Don't want to be a Premium member but still want to support us?

Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal

Or Donate anonymously using crypto!


0xfe58350B80634f60Fa6Dc149a72b4DFbc17D341E copy


3ATGMxNzCUFzxpMCHL5sWSt4DVtS8UqXpi copy

Thank you for your support!

Follow Us on Twitter!