Hi again!
Ecpella hypothetical case study. A 🧵

28yo 👨‍🦰with end stage DCM on the urgent list for heart transplantation ( milrinone dependent, INTERMACS 3) .
VT storm today --> deterioration to INTERMACS 1 (crash and burn)
pVA ECMO inserted. Flow 4lpm
CXR post ECMO insertion 24h later.
You've already guessed what's going to happen:
🟠AV not opening, flat art line
🔴LA + LV + A root filled with smoke
🟢Severe MR
🟡 PCWP 35 ( I know, the PAC is "radiolucent" in this CXR 😅)
🔵 High VT burden, inotropes ⏫⏫⏫
🟣 ⏫ O2 requirements

What can you do?

Hi!
Ready for a VV ECMO case? 🍿
A 🧵...
54yo male,end stage IPF active on the lung transplant list.
Cannulated and retrieved from his local hospital for respiratory failure.
Post admission CXR below. What's missing in this film? Yes, there is no ETT.
He was cannulated awake and we'll try to keep him self ventilating until the transplant surgery.
VV ECMO as a bridge to transplant is fascinating, but not easy.
There must an MDT agreement before proceeding. It doesn't work for all patients!
What next?

Morning everyone!Curious to see what happened to our patient?
Well, 48h have gone by and she's responded very well to so far. FiO2 is 0.35, fluid balance is 5L negative and her PP is 25 mm Hg.
Let's do a sedation hold.... oh, no..
EMERGENCY BUZZER. 🧵 She is on VT with no pulsatility and MAP is 24 mm Hg.
ECMO flow 🔽 1.5 lpm and is fluctuating, drainage pressure is -160. Thomas, The ECMO CNS looking after the patient, tells you he cannot increase the flow.
A cardiac arrest call is put out

Device of the day - Intra-Aortic Balloon Pump (IABP)

The most widely used circulatory support device – cheap, low cost, with relatively few complications. The IABP is designed to be situated in the descending aorta, distal to the left subclavian artery and proximal to the... renal arteries. It should inflate at the onset of diastole (aortic valve closure) and deflate prior to the beginning of systole.

It is used to support critically ill patients in a few ways, fundamentally providing circulatory, coronary and ventricular support...

Today we want to focus on measures to ensure ECMO cannulae remain well positioned and are safely secured. At @ITUHarefield we use a 4 point safety bundle to ensure cannulae safety. Any guesses what they are? @ECMOprincess @Jo_anneFowles @BenJBW @NurseRosieCJ @FOAMecmo @ECMOdaily 1️⃣ Sutures! A minimum of three sutures, well secured and appropriately positioned. (Picture is quite outdated but it shows the sutures)

Morning everyone. Here’s a challenge to start the day. Can you figure out what MCS this patient is receiving by looking at these pipes?? Thanks for any amplification @ECMOdaily @FOAMecmo @iceman_ex @Pipes_n_pumps @EuroELSO

Cardiogenic shock team assemble - a powerful coalition of specialties and disciplines able to rapidly assess and deploy the right treatment for the right patient at the right time in the right place. The patient is arriving in 10minutes…… Severe right ventricular failure on #echofirst and SCAI E+ cardiogenic shock. Placed immediately on peripheral VA ECMO